Herpes Simplex Polyganglionitis:  The Great Masquerader

Kedar K. Adour, MD
Arch Intern Med. 1979;139(12):1339-1340. doi:10.1001/archinte.1979.03630490009006.
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In this issue of the Archives (see p 1423), Drs Magnussen and Patanella reemphasize that the ubiquitous herpes simplex virus (HSV) has been isolated from the trigeminal, vagal, and superior cervical ganglion1 of unselected human cadavers; they used conventional laboratory methods to diagnose probable HSV recurrent laryngeal nerve palsy. Unfortunately, HSV is unconventional, defying the rules of virologic diagnosis—the authors have adequately described a "catch-22" situation. Further frustration in HSV diagnosis arises because recurrent HSV infection frequently occurs as a secondary manifestation of a primary viral infection. For example, in one of our patients with proven infectious mononucleosis caused by the Epstein-Barr virus (EBV), multiple symptoms of cranial neuritis developed, including unilateral trigeminal, second cervical, and glossopharyngeal Nerve hypesthesia with superior laryngeal and facial nerve paralysis (Bell's palsy). Herpetic inclusion bodies were found in mucocutaneous vesicles. The HSV complement fixation antibody titer was 1:32 in both the acute and


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