BMC Pediatrics

Neonatal herpes simplex virus (HSV) infection is rare and has significant morbimortality rates. Approximately 85% of newborns are infected intrapartum, and risk factors for mother-to-child transmission include vaginal delivery, primary maternal infection, and prolonged rupture of membranes. Neonatal HSV can manifest with isolated mucocutaneous lesions, neurological involvement, or disseminated disease. In general, herpetic infection can cause blepharoconjunctivitis or keratitis. We report a rare case of congenital herpes with ophthalmologic manifestations and multisystemic involvement.

A preterm infant, born at 32 weeks and 2 days, with presumed neonatal infection developed intestinal and respiratory complications, as well as hyperemic lesions on the left nostril and oral mucosa. An ophthalmological assessment was requested and brought up the suspicion of HSV infection, indicating empirical treatment with endovenous acyclovir. Later, a new ocular examination was suggestive of panuveitis. Afterward, serum IgM antibodies to HSV-1 and HSV-2 were positive. Proper antiviral therapy led to an improvement in the condition.

The proper antiviral therapy, initiated empirically with endovenous acyclovir (and later oral), following suspicion raised by the ophthalmological assessment (which identified signs of retinal necrosis in the Right Eye (RE) and opacification in the Left Eye (LE)), and confirmed by positive serum IgM antibodies to HSV-1 and HSV-2, resulted in an improvement in the patient's condition (regression of corneal edema and no progression of retinal necrosis). Although the patient developed necrotizing enterocolitis requiring surgical resection of 15 cm of the ileum, the treatment made it possible to preserve the integrity of the posterior pole of the RE and prevent the spread of infection to the LE. At the 8-month follow-up, the child showed interest in objects > 10 cm in diameter. The report concludes that the ocular assessment was crucial in the correct diagnosis and timely initiation of antiviral therapy, leading to an improved prognosis.

In the management of neonatal HSV, early diagnosis is essential for the timely initiation of antiviral therapy. Our report highlights that ocular assessment can be crucial in the correct diagnostic investigation of this condition.