Abstract：
An 89-year-old man was admitted because of persistent fever and impaired consciousness. On admission, his consciousness level was E3V3M4 according to the Glasgow Coma Scale. MRI of the brain showed high intensity lesions in the bilateral cingulate gyri. In the cerebrospinal fluid, both cell counts and glucose level were in the normal ranges. He had received antibiotics and intravenous isotonic saline. On the fifth day of hospitalization, blood examination revealed elevation of anti-herpes simplex virus (HSV) immunoglobulin M antibody, and herpes simplex encephalitis (HSE) was diagnosed. Despite treatment with acyclovir, his respiratory function and consciousness level deteriorated rapidly. On the eighth day, he died of respiratory failure. At autopsy, the brain showed multiple softenings of the gray and white matter in the hippocampus, amygdala, and temporal, insular, and cingulate cortices. Some of these lesions were hemorrhagic. Microscopic examination revealed that the lesions were necrotic and associated with perivascular inflammatory cell infiltration in the limbic system, hypothalamus, brainstem tegmentum area, and medulla. Eosinophilic intranuclear inclusions were rarely found in the astrocytes in the medulla. Immunohistochemistry revealed anti-HSV-1 antibody positive neurons in the brainstem tegmentum including reticular formation and the raphe nuclei. HSV-DNA was also detected in the postmortem cerebrospinal fluid. This was a rare case of HSE in which inflammation in the brainstem proved to be the cause of lethal respiratory failure.
摘要：
一名89岁的男子因持续发烧和意识障碍而入院。一入场,根据格拉斯哥昏迷量表，他的意识水平为E3V3M4。脑部MRI显示双侧扣带回的高强度病变。在脑脊液中，细胞计数和葡萄糖水平均在正常范围内.他接受了抗生素和静脉注射等渗盐水。住院的第五天,血液检查显示抗单纯疱疹病毒（HSV）免疫球蛋白M抗体升高，并诊断为单纯疱疹性脑炎（HSE）。尽管用阿昔洛韦治疗,他的呼吸功能和意识水平迅速恶化。第八天,他死于呼吸衰竭.尸检时,大脑表现出海马中灰质和白质的多次软化，杏仁核,和时间，岛屿,和扣带回皮质。其中一些病变是出血性的。显微镜检查显示病灶坏死，并伴有边缘系统血管周围炎性细胞浸润，下丘脑,脑干区，还有髓质.在髓质的星形胶质细胞中很少发现嗜酸性粒细胞核内包涵体。免疫组织化学显示脑干被膜中的抗HSV-1抗体阳性神经元，包括网状结构和中缝核。在死后脑脊液中也检测到HSV-DNA。这是一种罕见的HSE病例，其中脑干炎症被证明是致命的呼吸衰竭的原因。
