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Background:HSV2 associated encephalitis is a rare occurrence, described in neonates and immunocompromised individuals.

Case presentation:We describe a case of HSV-2 associated encephalitis associated with genital herpetic lesions. MRI brain showed large confluent T2/FLAIR hyperintensities involving left medial temporal lobe, left insula and left anterior cingulate gyrus. LP-CSF showed presence of marked neutrophilic leucocytosis mimicking  a pyogenic meningo-encephalitis etiology. CSF biofire ME test (Film Array Multiplex PCR based Meningoencephalitis panel) was positive for HSV-2.  The patient was treated with IV acyclovir for 14 days and subsequent to improvement in symptoms was discharged. In view of recurrence of symptoms he required readmission and was given a further 14 day course of IV Acyclovir and subsequent to normalization of CSF parameters was discharged. Our patient required prolonged course of IV acyclovir of more than 3 weeks. Conclusion:This serves to highlight that treatment in HSV-2 encephalitis may need to be prolonged if the patient is not having resolution of symptoms or acellularity in CSF/ negative PCR report has not been achieved.   

ABSTRACT

Background

Ureteral duplications are among the most common anomalies of the urinary tract. However, complete ureteral duplication, in which two ureters originating from the same kidney merge distally and then open separately into the bladder, is a rarer variation. This case report presents a female patient with a distal ureteral stone who underwent successful surgical management, highlighting the clinical significance and surgical approach to this rare anatomical variation.

Case Presentation

This case report discusses in detail the successful surgical management of a patient with a stone in the right distal ureteral segment and right complete ureteral duplication, a rarer variation where two ureters arising separately from the same kidney form a confluence point in the distal segment and subsequently open independently into the bladder.

Conclusion

Complete ureteral duplication can often be overlooked during preoperative imaging. This case highlights the importance of detailed radiological assessment and surgical planning in managing such anomalies.

Keywords: Case report, Complete ureteral duplication, Obstruction, Ureteral calculi, Ureterorenoscopy