[Acute necrotizing herpetic encephalitis with a spontaneously improving clinical course]

Area of Science:

• Neurology
• Immunology
• Virology

Background:

• Recurrent herpetic keratitis can lead to severe neurological complications.
• Herpes simplex virus (HSV) encephalitis poses significant diagnostic and therapeutic challenges.

Observation:

• A 70-year-old man presented with meningoencephalitis, transient hemiplegia, and consciousness disorders following recurrent herpetic keratitis.
• Electroencephalogram (EEG) and CT scans revealed right temporal lobe abnormalities.
• Elevated anti-HSV antibodies (IgG and IgM) were detected in serum and cerebrospinal fluid (CSF).

Findings:

• The patient later developed status epilepticus, with CT showing a right temporal hypodense area and CSF analysis revealing pleocytosis, elevated protein, and IgG.
• Persistent high titers of anti-HSV IgG were observed in serum and CSF.
• Despite significant temporal lobe pathology, neuropsychological testing showed no memory impairment.

Implications:

• The case highlights the potential for persistent inflammation following HSV encephalitis.
• An efficient host immune response to a latent HSV infection may contribute to an unusual, benign clinical course.
• Unilateral temporal lobe necrosis might explain the absence of amnesic sequelae, a common deficit in HSV encephalitis.