• Giulia Berzero, Anna Luisa Di Stefano, Caroline Dehais, Marc Sanson, Paola Gaviani, Antonio Silvani, Andrea Salmaggi, Paolo Vitali, Luca Diamanti, Fausto Baldanti, Lisa Maria Farina, Mauro Ceroni, and Enrico Marchioni.
• C. Mondino National Institute of Neurology Foundation, IRCCS, Pavia, Italy Neuroscience Consortium, University of Pavia, Monza Policlinico and Pavia Mondino, Pavia, Italy.
• J. Neurol. Neurosurg. Psychiatr.. 2015 Apr 1;86(4):374-7.

ObjectivesIn recent years, herpes simplex encephalitis (HSE) has been reported with increasing frequency in settings of immunosuppression, such as acquired immunodeficiency, transplantation and cancer. As observed, in immunocompromised individuals HSE presents peculiar clinical and paraclinical features, and poorer prognosis.MethodsHere we describe a retrospective series of seven cases of HSE in patients with high-grade glioma (HGG), collected among three institutions in a 5-year period (during this time, a total of 1750 patients with HGG were treated).ResultsDiagnosis of the condition was particularly challenging due to the confounding clinical presentation and the atypical biological findings. As a result, antiviral treatment was started with a sharp delay compared with immunocompetent hosts. Prognosis was poor, with high short-term mortality and severe residual disability in survivors.ConclusionsThe substantial incidence of HSE observed in our centres together with the difficulty in diagnosing the condition suggest that the incidence of this complication may be highly underestimated. The aim of our report is to strengthen the observation of HSE in patients with HGG and outline the key elements that may allow its diagnosis.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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