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Case Series
4 (
2
); 176-179
doi:
10.4103/0976-3147.112756

Pitfalls associated with the diagnosis of herpes simplex encephalitis

Department of Neurology, Municipal Hospital Landshut, Germany
Address for correspondence: Dr. Josef G. Heckmann Department of Neurology, Municipal Hospital Landshut Robert‑Koch Str. 1, 84034 Landshut Germany josef.heckmann@klinikum.landshut.de
Licence
This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Disclaimer:
This article was originally published by Thieme Medical and Scientific Publishers Private Ltd. and was migrated to Scientific Scholar after the change of Publisher.

Abstract

ABSTRACT

Herpes simplex encephalitis (HSE) still remains a serious illness with high morbidity and mortality. The characteristic presentation of HSE usually consists of fever, headache, and altered mental function. We present three patients with atypical features of HSE. First, a 48‑year‑old man with symptomatic posttraumatic epilepsy, who developed a gastrointestinal infection, seizures, and fever. After significant clinical improvement, the patient had fever again and developed a status epilepticus, which led to the diagnosis of HSE. Second, an 84‑year‑old woman with hyperactive delirium after levofloxacin intake. Cranial computed tomography (CCT) revealed hypodense temporal changes, prompting lumbar puncture and diagnosis of HSE. Third, a 51‑year‑old diabetic woman presented with fever and acute confusion. As CCT and cell count of cerebrospinal fluid (CSF) were normal, infection and hyperglycemia as initial diagnoses were postulated. Due to aphasic symptoms, the differential diagnosis of a stroke was taken into account. Thus a second lumbar puncture led to the correct diagnosis of HSE. These atypical presentations need a high grade of suspicion and a high willingness to reconsider the initial working diagnosis, in order to prevent a diagnostic delay.

Keywords

Acyclovir
atypical course of disease
cerebrospinal fluid
consciousness disturbance
herpes simplex encephalitis
herpes simplex virus

Conflict of Interest

None declared

References

  1. , , , , , , et al . Viral encephalitis: A review of diagnostic methods and guidelines for management. Eur J Neurol. 2005;12:331-43.
    [Google Scholar]
  2. , . Herpes simplex encephalitis: Adolescents and adults. Antiviral Res. 2006;71:141-8.
    [Google Scholar]
  3. , , , . Herpes simplex encephalitis and management of acyclovir in encephalitis patients in France. Epidemiol Infect. 2012;140:372-81.
    [Google Scholar]
  4. , , , , , , . Atypical herpes simplex virus encephalitis diagnosed by PCR amplification of viral DNA from CSF. Neurology. 1998;51:554-9.
    [Google Scholar]
  5. , , , , , , et al . The management of encephalitis: Clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2008;47:303-27.
    [Google Scholar]
  6. , . Viral encephalitis: Causes, differential diagnosis, and management. J Neurol Neurosurg Psychiatry. 2004;75:i10-5.
    [Google Scholar]
  7. , , . Quinolones: Review of psychiatric and neurological adverse reactions. Drug Saf. 2011;34:465-88.
    [Google Scholar]
  8. , , . Non-dominant hemisphere encephalitis in patient with signs of viral meningitis, New York, USA. Emerg Infect Dis. 2009;15:1320-1.
    [Google Scholar]
  9. , . Herpes simplex virus encephalitis: New infection or reactivation? Curr Opin Neurol. 2011;24:268-74.
    [Google Scholar]
  10. , , , , , . Herpes simplex encephalitis in older adults. J Am Geriatr Soc. 2010;58:201-2.
    [Google Scholar]
  11. , , , , , , et al . Herpes simplex virus encephalitis despite normal cell count in the cerebrospinal fluid. Crit Care Med. 2012;40:1304-8.
    [Google Scholar]
  12. , , . Atypical case of Herpes simplex encephalitis. Int Med J. 2008;38:294-5.
    [Google Scholar]
  13. , , , , . Herpes simplex encephalitis with a normal cerebrospinal fluid. Med Clin (Barc). 2004;122:357-8.
    [Google Scholar]
  14. , , . Herpes simplex encephalitis-an atypical case. Infection. 2001;29:357-8.
    [Google Scholar]
  15. , , , , , , . Atypical presentation of herpes simplex encephalitis in an infant. J Am Osteopath Assoc. 2010;110:615-7.
    [Google Scholar]
  16. , , , , . Herpes simplex encephalitis with two false-negative cerebrospinal fluid PCR tests and review of negative PCR results in the clinical setting. Case Rep Neurol. 2011;3:172-8.
    [Google Scholar]
  17. , , , , . Diagnostic delay in a case of herpes simplex encephalitis. BMJ Case Rep 2009 pii: bcr12.2008.1350
    [Google Scholar]

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