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KMID : 1034720200120020083
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Journal of Neurosonology and Neuroimaging
2020 Volume.12 No. 2 p.83 ~ p.86
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Acyclovir-Responsive Glioma: The Need for Vigilant Diagnosis
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Min Young-Gi
Kim Hae-Lim
Kim Seon-Deuk
Lee Woo-Jin
Song Seung-Geun
Lee Sang-Hyung
Lee Yong-Seok
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Abstract
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We report a case of an acyclovir-responsive glioma, which was initially misdiagnosed as herpes simplex encephalitis (HSE). Intravenous acyclovir alone, without corticosteroid, dramatically improved the patient’s symptoms and magnetic resonance imaging findings. He developed headache and amnesia after 1 year, when the stereotactic brain biopsy confirmed the final diagnosis of a glioblastoma, isocitrate dehydrogenase-1 wild-type. In retrospect, some of his sero-radiologic findings were not consistent with HSE. Polymerase chain reaction for herpes simplex virus in the cerebrospinal fluid tested negative. Parieto-occipital involvement and absence of post-treatment atrophy were also signs against HSE. We suggested that a low-grade glioma was present from the beginning and later underwent malignant transformation. The diagnosis of HSE should be made carefully. Acyclovir might also work on gliomas; this is confirmed by a typical clinical picture of HSE and a clear acyclovir-response. A vigilant review of the paraclinical features may shed light on the correct diagnosis.
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KEYWORD
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Encephalitis, herpes simplex, Glioblastoma, Neuroimaging, Neuropathology
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