Herpes Simplex Virus Type 2 Radiculomyelitis Disguised as Conversion Disorder

We report the case of a patient with a lengthy psychiatric history who presented with lower extremity pain and weakness. Cervical, thoracic, and lumbar MRI scans with and without gadolinium contrast revealed no significant stenosis, neural compression, or other abnormal findings, and the brain MRI with and without gadolinium contrast was normal. The initia l diagnosis was conversion disorder due to myriad psychological stressors. Polymerase chain reaction (PCR) of CSF detected HSV-2 and a lymphocytic pleocytosis, and the diagnosis of radiculomyelitis was confirmed. She was treated with i.v. acyclovir for 3 weeks followed by valacyclovir. The patient a ttained no improvement of her symptoms within 8 months; however, she reported decreased pain and improved strength of the lower extremities by 17 months. Neurologists should be aware of the association between HSV-2 and radiculomyelitis, particularly in the setting of a patient with psychiatric como rbidities. Recognition of HSV-2 through PCR of CSF and prompt treatment with acyclovir may prevent devastating neurological sequelae.Case Rep Neurol 2019;11:117 –123
Source: Case Reports in Neurology - Category: Neurology Source Type: research

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