Zosteriform herpes simplex virus type 2 presenting as Brown-Sequard syndrome in an immunocompromised man

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20 Oct 2026 0 comments

Herpes simplex virus type 2 (HSV-2) is a neurotropic virus affecting >500 million people worldwide and is most frequently associated with oral and genital ulceration. After primary infection, it establishes latency in sensory nerve ganglia and can reactivate later in life, leading to neurological complications such as meningitis, encephalitis and less commonly, spinal cord disease. Early identification and treatment of neurological manifestations are essential for preventing death and limiting neurological disability.

We describe a man with a thoracic zosteriform HSV-2 infection associated with longitudinally extensive transverse myelitis (LETM). He had recently been diagnosed with mantle cell lymphoma. He had initially presented with progressive asymmetric lower limb weakness, ipsilateral dorsal column impairment and contralateral spinothalamic loss, consistent with a Brown-Séquard (hemi-cord) syndrome.

A 78-year-old previously independent man presented with a 1-week history of abdominal pain and difficulty walking. He had well-controlled hypertension, previous prostate cancer and a recent diagnosis of mantle...