TY - JOUR
T1 - Herpes simplex virus-1 encephalitis induced by chemoradiotherapy and steroids in an esophageal cancer patient
T2 - A case report
AU - Saito, Masaaki
AU - Kiyozaki, Hirokazu
AU - Obitsu, Tamotu
AU - Imoto, Hirofumi
AU - Taniyama, Yusuke
AU - Takata, Osamu
AU - Rikiyama, Toshiki
N1 - Publisher Copyright:
© 2016 Saito et al.
PY - 2016/3/17
Y1 - 2016/3/17
N2 - Background: Systemic chemotherapy combined with steroids used as prophylactic antiemetics have been reported to induce immunosuppression. Further, herpes simplex virus-1 (HSV-1) infection has been reported to occur in patients with small cell carcinomas after chemoradiotherapy that includes brain irradiation. Here, we report a case of HSV-1 encephalitis that occurred in a patient undergoing chemoradiotherapy for advanced esophageal cancer. Case presentation: A 77-year-old woman received chemoradiotherapy (5-fluorouracil, 700 mg/m2; cisplatin, 70 mg/m2; and radiotherapy, 60 Gy in total) for stage III esophageal cancer. The total radiation dose was administered concurrently with the first two courses of chemotherapy, together with dexamethasone as a prophylactic antiemetic. Two days before completion of the fourth course of chemotherapy, the patient developed acute neurological symptoms of disorientation, clouding of consciousness, and fever. T2-weighted magnetic resonance imaging showed a high intensity area in the bilateral temporal lobes and insular cortex. Furthermore, DNA PCR testing of cerebrospinal fluid showed clear positivity for HSV-1 DNA, and the patient was diagnosed with herpetic encephalitis. Intravenous administration of acyclovir for 3 weeks led to gradual improvement of consciousness, and the patient was able to respond to verbal cues. Conclusion: In advanced esophageal cancer patients, standard treatment involves chemoradiotherapy and surgery. However, primary infection with or reactivation of endogenous latent HSV-1 in the brain cortex during chemoradiotherapy combined with administration of a steroid may compromise the benefits of treatment.
AB - Background: Systemic chemotherapy combined with steroids used as prophylactic antiemetics have been reported to induce immunosuppression. Further, herpes simplex virus-1 (HSV-1) infection has been reported to occur in patients with small cell carcinomas after chemoradiotherapy that includes brain irradiation. Here, we report a case of HSV-1 encephalitis that occurred in a patient undergoing chemoradiotherapy for advanced esophageal cancer. Case presentation: A 77-year-old woman received chemoradiotherapy (5-fluorouracil, 700 mg/m2; cisplatin, 70 mg/m2; and radiotherapy, 60 Gy in total) for stage III esophageal cancer. The total radiation dose was administered concurrently with the first two courses of chemotherapy, together with dexamethasone as a prophylactic antiemetic. Two days before completion of the fourth course of chemotherapy, the patient developed acute neurological symptoms of disorientation, clouding of consciousness, and fever. T2-weighted magnetic resonance imaging showed a high intensity area in the bilateral temporal lobes and insular cortex. Furthermore, DNA PCR testing of cerebrospinal fluid showed clear positivity for HSV-1 DNA, and the patient was diagnosed with herpetic encephalitis. Intravenous administration of acyclovir for 3 weeks led to gradual improvement of consciousness, and the patient was able to respond to verbal cues. Conclusion: In advanced esophageal cancer patients, standard treatment involves chemoradiotherapy and surgery. However, primary infection with or reactivation of endogenous latent HSV-1 in the brain cortex during chemoradiotherapy combined with administration of a steroid may compromise the benefits of treatment.
KW - Chemoradiotherapy
KW - Encephalitis
KW - Esophageal cancer
KW - HSV-1
UR - http://www.scopus.com/inward/record.url?scp=84977665299&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84977665299&partnerID=8YFLogxK
U2 - 10.1186/s12885-016-2255-8
DO - 10.1186/s12885-016-2255-8
M3 - Article
C2 - 26988237
AN - SCOPUS:84977665299
SN - 1471-2407
VL - 16
JO - BMC Cancer
JF - BMC Cancer
IS - 1
M1 - 233
ER -
