Aortitis and Malacoplakia-like Lesions of the Brain in Association with Neonatal Herpes Simplex

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Abstract
A report of a case of a neonate with herpes simplex infection, who died 85 days after development of skin vesicles, is presented. The clinical course was characterized by lethargy, convulsions, abnormal spinal fluid findings, irritability, microcephaly, and failure to thrive. Herpesvirus was isolated from the spinal fluid, throat, and stool. Necropsy revealed large porencephalic cysts and massive destruction of the cerebral cortex, thickening of the aorta and narrowing of the ascending aortic branches, and small pinpoint nodules in the adrenal glands. Microscopically, severe necrotizing meningoencephalitis with massive calcification and curious malacoplakia-like bodies was seen in the brain; necrotizing vasculitis with severe intimal fibrosis, calcification and giant cells of the aorta and its ascending branches, and focal necrosis with calcification, fibrosis and giant cells were found in the adrenal glands. A discussion of involvement of the brain in cases of neonatal herpes simplex and vascular involvement by herpes and other viruses is also presented.

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