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Case 32 - Herpes Encephalitis Recurrence?

from Part 7 - Misinterpreting Test Results

Published online by Cambridge University Press:  03 November 2020

Keith Josephs
Affiliation:
Mayo Clinic Alzheimer’s Disease Research Center
Federico Rodriguez-Porcel
Affiliation:
Medical University of South Carolina
Rhonna Shatz
Affiliation:
University of Cincinnati
Daniel Weintraub
Affiliation:
University of Pennsylvania
Alberto Espay
Affiliation:
University of Cincinnati
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Summary

This 52-year-old man presented to the emergency room with aggressive behavior and emotional lability progressing over the previous three days. He had completed a three-week course of acyclovir for the treatment of herpes simplex encephalitis (HSE) two weeks prior. Other than residual mild memory difficulties, he was fully functional until his more recent behavioral changes. He was afebrile and his vitals were within normal limits. He was irritable and his attention fluctuated. His exam otherwise unremarkable. MRI of the brain with and without contrast was unremarkable. Laboratory results were significant only for mildly increased CSF protein (100 mg/dl normal range: 15–45 mg/dl). Given the concern of HSE relapse, he was placed on acyclovir again.

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Publisher: Cambridge University Press
Print publication year: 2020

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References

Armangue, T. et al. 2015. Autoimmune post-herpes simplex encephalitis of adults and teenagers. Neurology 85(20) 17361743.CrossRefGoogle ScholarPubMed
Galli, J., Clardy, S. L. and Piquet, A. L. 2017. NMDAR encephalitis following herpes simplex virus encephalitis. Curr Infect Dis Rep 19(1) 1.CrossRefGoogle ScholarPubMed
Skoldenberg, B. et al. 2006. Incidence and pathogenesis of clinical relapse after herpes simplex encephalitis in adults. J Neurol 253(2) 163170.CrossRefGoogle ScholarPubMed

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