Herpes simplex encephalitis as a fatal disease

Abstract EN

Herpes simplex encephalitis (HSE) is a fatal infectious disease with high mortality if misdiagnosed or untreated.

It can presents with acute features such as a headache, fever, seizures and confusion.

It sometimes suspected as meningitis before MRI, and then the patient loses a chance for survival because of late diagnosis, and late treatment as a result.

The combination of clinical history and examination, brain computed tomography scan, magnetic resonance imaging (MRI), and cerebrospinal fluid (CSF) analysis have been used to establish the diagnosis.

Here, we are presenting a rare case of HSE presenting as confusion, fever and disorientation with nonspecific CSF analysis, then seizures, and typical MRI findings consistent with HSE and CSF polymerase chain reaction positive for herpes simplex virus-1 DNA.

Unfortunately the diagnosis was late, and even with acyclovir the patient died after 2 weeks.

Herpes simplex encephalitis must be suspected in a patient with disoriented with coma or seizures, and MRI gives the best view for direction the management.