EJMCR |

Case Report

Published: Apr 03, 2025 | DOI: 10.24911/ejmcr.9-1602

A tale of concealed source and bizarre CSF in an immunocompetent HSV2 Encephalitis patient

Authors: Dr Satyan Nanda , Dr Vijyeta Taparia , Dr Jitendra Sharma , Dr Ravi Shekhar , Dr Shalini Arora , Dr Rahul Handa

Article Info

Authors

Dr Satyan Nanda

Senior Consultant and Head, Department of Neurology, Yatharth Hospital and Wellness Centre, Sec 110, Noida

Dr Vijyeta Taparia

Associate Consultant, Department of Neurology, Yatharth Hospital and Wellness Centre, Sec 110, Noida.

Dr Jitendra Sharma

Senior Medical Officer, Department of Neurology, Yatharth Hospital and Wellness Centre, Sec 110, Noida

Dr Ravi Shekhar

Senior Consultant and Head, Department of Radiology, Yatharth Hospital and Wellness Centre, Sec 110, Noida

Dr Shalini Arora

Senior Consultant and Head, Department of Pathology, Yatharth Hospital and Wellness Centre, Sec 110, Noida

Dr Rahul Handa

Staff Specialist( Neurology) Gold Coast University Hospital, Southport, Queensland, Australia

Publication History

Received: November 24, 2024

Accepted: March 18, 2025

Published: April 03, 2025

Abstract

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.

Keywords: HSV2 associated Encephalitis, Viral CSF pleocytosis, Temporal Lobe encephalitis, Genital Herpes

Pubmed Style

Dr Satyan Nanda, Dr Vijyeta Taparia, Dr Jitendra Sharma, Dr Ravi Shekhar, Dr Shalini Arora, Dr Rahul Handa. A tale of concealed source and bizarre CSF in an immunocompetent HSV2 Encephalitis patient. EJMCR. 2025; 03 (April 2025): -. doi:10.24911/ejmcr.9-1602

Web Style

Dr Satyan Nanda, Dr Vijyeta Taparia, Dr Jitendra Sharma, Dr Ravi Shekhar, Dr Shalini Arora, Dr Rahul Handa. A tale of concealed source and bizarre CSF in an immunocompetent HSV2 Encephalitis patient. https://ejmcr.com/index.php/articles/1602 [Access: April 25, 2025]. doi:10.24911/ejmcr.9-1602

AMA (American Medical Association) Style

Vancouver/ICMJE Style

Dr Satyan Nanda, Dr Vijyeta Taparia, Dr Jitendra Sharma, Dr Ravi Shekhar, Dr Shalini Arora, Dr Rahul Handa. A tale of concealed source and bizarre CSF in an immunocompetent HSV2 Encephalitis patient. EJMCR. (2025), [cited April 25, 2025]; 03 (April 2025): -. doi:10.24911/ejmcr.9-1602

Harvard Style

Dr Satyan Nanda, Dr Vijyeta Taparia, Dr Jitendra Sharma, Dr Ravi Shekhar, Dr Shalini Arora, Dr Rahul Handa (2025) A tale of concealed source and bizarre CSF in an immunocompetent HSV2 Encephalitis patient. EJMCR, 03 (April 2025): -. doi:10.24911/ejmcr.9-1602

Chicago Style

Dr Satyan Nanda, Dr Vijyeta Taparia, Dr Jitendra Sharma, Dr Ravi Shekhar, Dr Shalini Arora, Dr Rahul Handa. "A tale of concealed source and bizarre CSF in an immunocompetent HSV2 Encephalitis patient." 03 (2025), -. doi:10.24911/ejmcr.9-1602