Disseminated Herpes Simplex Virus Infection and Capillary Leak Syndrome in Preterm Twins

Disseminated herpes simplex virus (HSV) can be life-threatening in neonates without treatment. We present a case involving twins diagnosed with disseminated HSV who experienced different clinical courses. Twin A was more severely affected, developing severe capillary leak syndrome (CLS) that led to cardiovascular compromise, acute kidney injury, and hepatic failure. However, with innovative immunologic treatment and expert hemodynamic management, the patient recovered despite high mortality in infants with this presentation. Twin B had a less severe initial presentation but experienced long-term neurologic sequelae, including keratitis of both eyes occurring at different times and recurrent HSV meningitis. This case report displays novel translational and clinical methods that may improve survival in neonates with severe disseminated HSV and CLS.