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Herpes simplex encephalitis presenting with normal CSF analysis.

Author(s)
Rizwan Ahmed Department of General Medicine, Federal Govt. Polyclinic, PGMI, Islamabad, Pakistan
Ismaa Ghazanfar Kiani Department of General Medicine, Federal Govt. Polyclinic, PGMI, Islamabad, Pakistan
Faridullah Shah Department of General Medicine, Federal Govt. Polyclinic, PGMI, Islamabad, Pakistan
Rao Najeeb-Ur-Rehman Department of General Medicine, Federal Govt. Polyclinic, PGMI, Islamabad, Pakistan
M. Ehsan-Ul-Haq Department of General Medicine, Federal Govt. Polyclinic, PGMI, Islamabad, Pakistan
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.
Publication Details
Page(s) 815-817
DOI DOI not available
Published Journal: Journal of College of Physicians and Surgeons--Pakistan : JCPSP, Volume: 23, Issue: 11, Year: 2013

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