# Acute-Onset Lower Extremity Weakness and Urinary Retention in a Chronically Immunosuppressed Patient: Diagnosis and Management of Herpes Simplex Virus Type 2 Myelitis

## TL;DR

A chronically immunosuppressed man developed lower body weakness and urinary issues due to herpes simplex virus type 2 myelitis and fully recovered after treatment.

## Contribution

This case report highlights HSV-2 myelitis as a rare but treatable cause of acute neurological deficits in immunosuppressed individuals.

## Key findings

- HSV-2 myelitis presented with bilateral lower extremity weakness and urinary retention in an immunosuppressed patient.
- Diagnosis was confirmed via CSF and serum PCR testing for herpes simplex virus type 2.
- Treatment with IV steroids and antiviral therapy led to complete neurological recovery after four months of physical therapy.

## Abstract

A 34-year-old immunosuppressed male presented with worsening bilateral lower extremity weakness and urinary retention accompanied by a painless clean-based chancre on his glans penis. Physical examination revealed symmetrically diminished lower extremity weakness most pronounced with hip flexion and knee extension and absent Achilles reflexes. Full MRI spine without contrast was noncontributory. Lumbar puncture showed elevated protein and total nucleated cells with lymphocytic predominance. Both CSF and serum polymerase chain reaction were positive for herpes simplex virus type 2. He received IV methylprednisolone and acyclovir and underwent four months of physical therapy with complete resolution of his neurologic deficits.