{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T13:03:05Z","timestamp":1784898185515,"version":"3.55.0"},"reference-count":18,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:00:00Z","timestamp":1784678400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Children's Hospital of Soochow University","award":["2024 Research Project for Complex and Rare Disease"],"award-info":[{"award-number":["2024 Research Project for Complex and Rare Disease"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Child Neurol"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Recurrent herpes simplex virus type 1 (HSV-1) encephalitis in children is rare, and its pathophysiology remains incompletely understood. Both viral reactivation and host immune dysregulation have been implicated. Advances in metagenomic next-generation sequencing (mNGS) and immune profiling provide new opportunities to elucidate disease mechanisms.<\/jats:p>\n                    <jats:p>\n                      <jats:bold>Case Presentation:<\/jats:bold>\n                      We detail a 13-year-old boy of Qiang ethnicity who experienced 3 neurologic episodes, including 2 virologically confirmed HSV-1 encephalitis events over 7 years. The third recurrence involved fever, seizures, and progressive bilateral temporal lobe lesions visible on magnetic resonance imaging. Cerebrospinal fluid (CSF) mNGS confirmed HSV-1 reactivation, and viral genomic sequencing demonstrated a highly conserved viral genome without high-confidence nonsynonymous mutations. Immune profiling showed compartmentalized central nervous system inflammation with elevated CSF cytokines (interleukin [IL]-6, IL-8, IL-10, interferon [IFN]-\u03b1, IFN-\u03b3) and altered lymphocyte subsets, despite normal serum results. The patient was treated with acyclovir, intravenous immunoglobulin, and low-dose corticosteroids, which controlled seizures but left persistent neurocognitive deficits. Multidisciplinary follow-up is crucial to mitigate long-term neurocognitive sequelae.\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>Literature Review:<\/jats:bold>\n                      We reviewed 10 previously published pediatric cases of recurrent HSV-1 encephalitis, which demonstrated heterogeneous recurrence intervals, contralateral or novel lesion involvement, and frequent cognitive sequelae. Few studies integrated viral genomics or immune profiling.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The findings suggest that recurrent pediatric HSV-1 encephalitis may be driven by viral reactivation in the context of CNS-restricted immune dysregulation, rather than reinfection or viral evolution.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/08830738261465526","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T13:56:58Z","timestamp":1784728618000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Integrating Cerebrospinal Fluid Metagenomic Next-Generation Sequencing and Immune Profiling in Recurrent HSV-1 Encephalitis: A Case Report and Narrative Review"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-3200-560X","authenticated-orcid":false,"given":"Chen","family":"Xu","sequence":"first","affiliation":[{"name":"Children's Hospital of Soochow University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weihao","family":"Ling","sequence":"additional","affiliation":[{"name":"Children's Hospital of Soochow University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao","family":"Xiao","sequence":"additional","affiliation":[{"name":"Children's Hospital of Soochow University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manli","family":"Wang","sequence":"additional","affiliation":[{"name":"Children's Hospital of Soochow University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianchun","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Suzhou Wujiang District Children's Hospital, Suzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jihong","family":"Tang","sequence":"additional","affiliation":[{"name":"Children's Hospital of Soochow 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