The Man Who Thought He Had the Flu

General
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1

A 34-year-old previously healthy man presents with fever, headache, and mild confusion for 3 days. He says it felt like “just a flu” at first, but now he has trouble remembering things and feels mentally “foggy.” His wife reports he had a seizure the night before coming to the hospital. No history of trauma, substance use, or prior seizures. No recent travel or tick bites. He is fully vaccinated.

On examination:

  • Temp: 101.8°F (38.8°C)
  • BP: 122/80 mmHg
  • HR: 95 bpm
  • GCS: 14/15 (mild confusion)
  • No neck stiffness
  • No focal neurological deficits
  • Fundoscopy: Normal
  • Reflexes: Brisk

Investigations:

  • CBC and LFTs: Normal
  • MRI Brain: Hyperintensities in the temporal lobes
  • CSF: Lymphocytic pleocytosis, elevated protein, normal glucose
  • EEG: Sharp waves in the temporal region
  1. What is your provisional diagnosis and why?
  2. What tests would confirm it?
  3. What is the first-line treatment, and what is the urgency of initiating therapy?
2

Viral Encephalitis due to HSV?- tbh I’m not sure :sweat_smile:
If yes,
Tests:
PCR of HSV DNA
Serology tests
First line treatment: Acyclovir IV

3
  • Provisional diagnosis: Herpes Simplex Virus (HSV) Encephalitis—suggested by fever, confusion, seizure, temporal lobe involvement on MRI, and CSF lymphocytosis.
  • Confirmatory test: CSF PCR for HSV.
  • First-line treatment: IV Acyclovir, started immediately, even before PCR results.
4

Provisional Diagnosis: Herpes Simplex Encephalitis (HSE) due to symptoms like fever, confusion, seizures, and temporal lobe hyperintensities on MRI.

Confirmatory Test: PCR for HSV in CSF.

Treatment: Immediate initiation of IV Acyclovir.

Urgency: High; delaying treatment can lead to severe neurological damage or death.

5

Herpes simplex virus (HSV) encephalitis! Suggested by fever , confusion , seizure, temporal lobe MRI findings, lymphocytic CSF profile.

Confirmation test: CSF PCR for HSV DNA

First line treatment: immediate IV acyclovir

Start treatment empirically without waiting for test results delay can lead to more damage or even death.

6

Sounds like encephalitis..
PCR can be done for confirmation
Anti-viral to manage for Encephalitis, immaterial of being viral or not