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[Herpes simplex encephalitis complicated with cerebral salt wasting syndrome: a case study]
Fumiya Suzuki1, Sunao Takahashi1, Ayako Oniki1
1Department of Neurology, JA Toride Medical Center.
Rinsho Shinkeigaku = Clinical Neurology
|July 28, 2024
Summary
This case highlights cerebral salt wasting syndrome (CSWS) in a patient with herpes simplex encephalitis. Prompt diagnosis and treatment of CSWS are crucial for managing hyponatremia in encephalitis patients.
Area of Science:
- Neurology
- Endocrinology
- Infectious Diseases
Background:
- Herpes simplex encephalitis (HSE) is a severe neurological condition.
- Hyponatremia is a common complication of encephalitis, often attributed to SIADH.
- Cerebral salt wasting syndrome (CSWS) is a less common cause of hyponatremia in encephalitis.
Observation:
- A 78-year-old male presented with fever, confusion, and hyponatremia.
- Cerebrospinal fluid analysis confirmed herpes simplex virus type 1 (HSV-1) infection.
- Clinical signs of dehydration were noted, suggesting salt depletion.
Findings:
- The patient was diagnosed with HSE and treated with acyclovir.
- Hyponatremia was identified as CSWS and managed with hypertonic saline and fludrocortisone.
- Successful treatment led to normalization of serum sodium and clearance of HSV-1 DNA.
Implications:
- This case underscores the importance of differentiating CSWS from SIADH in encephalitis.
- Accurate diagnosis is critical as CSWS and SIADH require distinct therapeutic approaches.
- Recognizing CSWS can improve patient outcomes in HSE and other neurological infections.
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