A Fatal Case of Herpes Simplex Encephalitis with Two False-Negative Polymerase Chain Reactions

Overview

Journal Case Rep Neurol

Publisher Karger

Specialty Neurology

Date 2018 Oct 5

PMID 30283319

Citations 7

Authors

Aldo A Mendez

Annaliese Bosco

Lama Abdel-Wahed

Kendra Palmer

Karra A Jones

Annie Killoran

Affiliations

Soon will be listed here.

Abstract

An 88-year-old man presented with a 1-month history of altered mental status and seizures. His electrographic and imaging findings were suggestive of herpes simplex encephalitis (HSE), for which he was empirically treated with acyclovir. He underwent two lumbar punctures 3 days apart; both cerebrospinal fluid analyses tested negative for herpes simplex virus (HSV) by polymerase chain reaction (PCR). These negative results and his continued deterioration after 9 days of acyclovir therapy prompted treatment with steroids for possible autoimmune encephalitis. Shortly after the change in management, the patient died from cardiac arrest. At autopsy, his brain showed both gross and microscopic evidence of encephalitis and was positive for HSV by immunohistochemistry. This fatal case of HSE emphasizes the limitations of HSV PCR and the importance of clinical suspicion in the diagnosis and management of this disease.

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