The Case of Ankit - Just fever or something more sinister?

General
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A 19-year-old male college student, Ankit is brought to the emergency department by his roommate. Over the past 2 days, he has become increasingly confused and disoriented. He was previously healthy but had been studying intensely and staying up late. The roommate noticed he had a fever and wasn’t making sense when he spoke. Today, he began having generalized seizures.

On examination:

  • Temperature: 38.9°C
  • BP: 118/76 mmHg, HR: 98 bpm
  • He is drowsy but arousable.
  • Oriented to person but not place or time
  • No neck stiffness
  • No focal neurological deficits
  • CSF: lymphocytic pleocytosis, elevated protein, normal glucose
  • MRI: hyperintensities in temporal lobes
  • EEG: periodic sharp waves in the temporal regions
2 Likes
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  • Ankit likely has herpes simplex virus (HSV) encephalitis.
  • Temporal lobe MRI changes, seizures, and altered mental status support this.
  • Immediate IV acyclovir is essential to prevent serious neurological damage or death.
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He might be having herpes simplex virus (HSV) encephalitis, giving the temporal lobe involvement, seizures and CSF findings.

MRI and EEG support the diagnosis. Start IV acyclovir immediately cuz early treatment is crucial to prevent more nerological damage.

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It is Herpes Simplex Virus(HSV) Encephalitis.

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Looks serious, not just fever. Maybe brain infection like encephalitis.

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Absolutely to the point and spot on!

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Absolutely correct <3

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herpes simplex virus (HSV) encephalitis

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HSV Encephalitis, I’m sure with the case…