Coexistent herpes simplex encephalitis and malignant astrocytoma

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Of the multitude of oncogenic viruses known to man, the herpesvirus is most commonly associated with malignancy. Herpesvirus Type II has been implicated as an oncogenic agent in carcinoma of the cervix.1–6 Epstein-Barr virus (EBV), a herpes-like virus, has been found with striking frequency in isolates of Burkitt’s lymphoma, Hodgkin’s lymphoma, and nasopharyngeal carcinoma.7–18 The purpose of this paper is to discuss the previously unreported entity of coexistent herpesvirus infection of the brain and malignant astrocytoma (glioblastoma multiforme) in three patients.

Case reports

Case 1. A 57-year-old man was confused and lethargic for 4 months before he was admitted to the Cleveland Clinic Hospital for the first time. H e had diarrhea which did not respond to tetracycline or penicillin therapy, and a temperature of 100 to 101 F. He was hospitalized 4 weeks in another hospital for treatment of viral pneumonia. After discharge the patient’s wife noted that he continued to be confused, repeated questions, and had lapses of memory, especially of recent events.

One month before admission to Cleveland Clinic Hospital the patient was rehospitalized because of persistent fever and confusion. Roentgenograms of the skull and chest and four electroencephalograms were interpreted as normal. The cerebro-spinal fluid contained 70 mg/100 ml glucose and 76 mg/100 ml protein. Direct smears and culture for acid-fast bacilli, fungus, and “routine” pathogens were negative; 5 mononuclear white blood cells and 328 red blood cells, mostly crenated, were seen. The patient was transferred to Cleveland Clinic Hospital for further evaluation and . . .



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