title: Herpes simplex encephalitis presenting with normal CSF analysis.
abstract: A 28 years old female presented with headache, fever, altered sensorium and right side weakness for one week. She was febrile and drowsy with right sided hemiplegia and papilledema. Tuberculous or bacterial meningitis, tuberculoma and abscess were at the top of the diagnosis list followed by Herpes simplex meningo-encephalitis (HSE). MRI showed abnormal signal intensity of left temporal lobe without significant post-contrast enhancement and midline shift. CSF examination was normal, gram stain and Ziehl-Neelsen stain showed no micro-organism, or acid fast bacilli. CSF for MTB PCR was negative. PCR DNA for Herpes simplex 1 on CSF was detected. Acyclovir was started and the patient was discharged after full recovery. A high index of suspicion is required for HSE diagnosis in Pakistan where other infections predominantly affect the brain and HSE may be overlooked as a potential diagnosis.
authors.affiliation: Department of General Medicine, Federal Govt. Polyclinic, PGMI, Islamabad.
authors.forename: Rizwan
authors.initials: R
authors.lastname: Ahmed
authors.forename: Ismaa Ghazanfar
authors.initials: IG
authors.lastname: Kiani
authors.forename: Faridullah
authors.initials: F
authors.lastname: Shah
authors.forename: Rao
authors.initials: R
authors.lastname: Najeeb-ur-Rehman
authors.forename: M
authors.initials: M
authors.lastname: Ehsan-ul-Haq
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D002555:Cerebrospinal Fluid / Q000821:virology; D004279:DNA, Viral / Q000134:cerebrospinal fluid; D020803:Encephalitis, Herpes Simplex / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D005334:Fever / Q000209:etiology; D018259:Herpesvirus 1, Human / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D008279:Magnetic Resonance Imaging; D010291:Paresis / Q000209:etiology; D016133:Polymerase Chain Reaction; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D000212:Acyclovir