Herpes simplex virus-2 myelitis persistence of viral replication despite resolution of symptoms: Case report and review of the literature

Acute transverse myelitis, an acute inflammation of the spinal cord, can be caused by HSV infection. We report a case of an 85-year-old man who presented with lower extremity weakness and flare-up of a vesicular rash on the sacral area. The patient was diagnosed with acute transverse myelitis based on MRI and CSF findings. CSF analysis showed a lymphocytic pleocytosis and positive HSV-2 PCR. The patient was started on intravenous acyclovir, with full clinical and radiologic improvement despite persistence of HSV-2 PCR positivity in the CSF for four months. A review of the literature of HSV myelitis is included. We conclude that testing of HSV PCR on repeated CSF samples might not accurately reflect viral activity in the setting of clinical improvement.