Diagnostic delay in a case of herpes simplex encephalitis
Zaid Shalchi1, Alan Bennett, David Hargroves
1William Harvey Hospital, Kennington Road, Willesborough, Ashford TN24 0LZ, UK.
BMJ Case Reports
|June 21, 2011
Summary
Herpes simplex encephalitis (HSE) is a rare but serious brain infection. Delayed diagnosis due to non-specific symptoms can lead to poor outcomes, highlighting the need for timely recognition and treatment.
Area of Science:
- Neurology
- Infectious Diseases
- Virology
Background:
- Herpes simplex encephalitis (HSE) is the leading cause of sporadic fatal encephalitis in Western countries.
- Early diagnosis via cerebrospinal fluid (CSF) PCR and prompt aciclovir treatment significantly improve patient prognosis.
- HSE presents with non-specific symptoms, often leading to misdiagnosis as systemic infections or non-infective encephalopathy.
Purpose of the Study:
- To report a case of HSE with significant diagnostic delay.
- To emphasize the challenges in recognizing HSE due to its non-specific presentation.
- To highlight the impact of delayed treatment on patient outcomes.
Main Methods:
- Case report of a patient with confirmed Herpes Simplex Virus type-1 (HSV-1) encephalitis.
- Review of diagnostic procedures including Magnetic Resonance Imaging (MRI) and CSF PCR.
- Analysis of the clinical course and treatment response.
Main Results:
- The patient presented with fever, headache, altered behavior, and generalized bradykinesia, initially misdiagnosed as otitis interna and later as an ischemic stroke.
- A 10-day delay occurred between symptom onset and the initiation of aciclovir treatment.
- MRI and CSF PCR confirmed HSV-1 infection; the patient showed improvement with aciclovir but sustained neurological deficits, including word-finding difficulties and cognitive slowing.
Conclusions:
- HSE can be challenging to diagnose due to non-specific symptoms, leading to diagnostic delays.
- Timely diagnosis and initiation of aciclovir are crucial for improving outcomes in HSE.
- Even with treatment, delayed diagnosis and management of HSE can result in significant long-term neurological disability.
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