Disseminated Neonatal Herpes Simplex Virus Infection Presenting with Pneumonia and Progressive Respiratory Failure

Disseminated neonatal herpes simplex virus (HSV) infection represents the most severe form of neonatal herpes, and is associated with high morbidity and mortality. Early recognition of disseminated HSV disease in the neonate can be difficult, since the clinical presentation often mimics bacterial sepsis with absence of cutaneous vesicles. We describe a 5-day-old male infant with disseminated HSV-2 disease, who initially presented with pneumonia and progressive respiratory failure requiring extracorporeal membrane oxygenation. Laboratory data were significant for leukopenia, thrombocytopenia and disseminated intravascular coagulation. Chest radiograph showed diffuse pulmonary infiltrates. Tracheal aspirate cultures grew HSV-2. The patient was treated with a 3 weeks course of intravenous acyclovir. The key feature in this case is to recognize that HSV can present in neonates with rapidly progressive pneumonitis and sepsis syndrome.