Double Trouble: Herpes Simplex Encephalitis Triggering Autoimmune Encephalitis

Herpes simplex virus 1 (HSV1) is the most common cause of sporadic encephalitis worldwide. Even with optimal treatment, half of these patients experience significant neurological sequelae. A subset of these patients has recurrent neurological syndromes, occurring within two to three months of disease onset. Often, these patients show no evidence of recurrent herpes simplex virus (HSV) infection. Many develop antibodies against the N-methyl-D-aspartate receptor (NMDAR) . Here, we describe a case of anti-NMDAR encephalitis occurring almost a year after the onset of HSV encephalitis.