Herpes Simplex Virus Type 1 Dorsal Root Ganglionitis in a 34 Year Old Male With Occipital Neuralgia Refractory to Medical and Radiofrequency Ablation Therapies: A Clinicopathological Report and Literature Review (P1.293)

Abstract

OBJECTIVE: The objective of this study was to better understand the pathogenesis of herpes simplex virus type 1 (HSV-1) infections of cervical dorsal root ganglia (DRG). BACKGROUND: Previous autopsy studies indicate that HSV-1 may establish latent infection in human cervical DRG. However, there is very limited information available about the clinical and histopathological presentation of active HSV-1 infection of cervical DRG. We present a case of HSV-1 cervical dorsal root ganglionitis in a patient who underwent surgical resection of bilateral C2-C3 DRG for occipital neuralgia. RESULTS: A 34 year old Caucasian homosexual male with past medical history of fibromyalgia, post-traumatic stress disorder and bilateral occipital headaches that started 15 years ago after a motor vehicle accident presented with a five week history of significantly worsened occipital headaches. There was no history of recent trauma, sickness, rash or overseas travel and CT and MRI of the cervical spine were unremarkable. The pain was refractory to medical therapy and bilateral occipital nerve radiofrequency ablation (RFA) provided only short term relief. Sixteen days following the failed RFA, the patient underwent surgical resection of bilateral C2 and C3 DRG with subsequent complete relief of the pain and significant functional improvement that continued through latest follow-up 2 months post-operatively. Histopathological examination of the removed ganglia revealed chronic inflammation, neuronophagia and immunohistochemical evidence of HSV-1 protein expression in neurons consistent with ganglionitis due to active productive HSV-1 infection. Literature review indicated that this case represents the first histopathologically documented HSV-1 cervical dorsal root ganglionitis in humans. CONCLUSIONS: These observations indicate that active HSV-1 infection can cause ganglionitis in human cervical DRG and suggest that HSV-1 infection may have played a role in the pathogenesis of the occipital headaches of this patient. Histopathological images and brief literature review of HSV-1 reactivation will be presented.

Disclosure: Dr. Rathore has nothing to disclose. Dr. Slavin has nothing to disclose. Dr. Rathore has nothing to disclose. Dr. Rakic has nothing to disclose. Dr. Valyi-Nagy has nothing to disclose.