Date of Presentation
5-2-2024 12:00 AM
College
Rowan-Virtua School of Osteopathic Medicine
Poster Abstract
Herpes simplex virus is common in the US, with an estimated seroprevalence of HSV-1 of 40% and HSV-2 of 11%. Although herpes encephalitis is rare, with an incidence of roughly 1/100,000 individuals per year in the US, the mortality rate of 70% and rapid progression make identification and treatment imperative.
An 85 year old woman was brought to the emergency department from nursing home with altered mental status of unknown duration in refractory status epilepticus on a background of dementia, history of multiple falls, and indwelling foley catheter in addition to hypertension and bilateral knee replacement. EEG demonstrated abnormal discharges in the right anterior temporal region on a background of diffuse slowing, consistent with temporal encephalitis; MRI showed no acute intracranial abnormality. Urinalysis demonstrated moderate bacteria in the urine and blood cultures demonstrated presence of Staphylococcus epidermidis and Streptococcus anginosus. CSF was negative for HSV1 and HSV2 IgG and IgM, but Meningitis Film array panel demonstrated HSV-1. The patient failed to improve after 5 days of acyclovir and the family opted for inpatient hospice.
This case demonstrates the importance of multiple diagnostic methods, as reliance on MRI and CSF PCR alone would have missed this fulminant progression. Additionally, acyclovir is recommended over valacyclovir by the Antimicrobial Stewardship Program.
Keywords
Herpes encephalitis, acute onset seizure, Nonepileptic Seizure, acyclovir, EEG, status epilepticus, Herpes virus 1
Disciplines
Diagnosis | Emergency Medicine | Health and Medical Administration | Infectious Disease | Medicine and Health Sciences | Pathological Conditions, Signs and Symptoms | Pharmaceutical Preparations | Therapeutics | Virus Diseases
Document Type
Poster
YouTube Video Link
Included in
Diagnosis Commons, Emergency Medicine Commons, Health and Medical Administration Commons, Infectious Disease Commons, Pathological Conditions, Signs and Symptoms Commons, Pharmaceutical Preparations Commons, Therapeutics Commons, Virus Diseases Commons
Out of Time: Altered Mental Status And Temporal Seizure On Background of Dementia & UTI
Herpes simplex virus is common in the US, with an estimated seroprevalence of HSV-1 of 40% and HSV-2 of 11%. Although herpes encephalitis is rare, with an incidence of roughly 1/100,000 individuals per year in the US, the mortality rate of 70% and rapid progression make identification and treatment imperative.
An 85 year old woman was brought to the emergency department from nursing home with altered mental status of unknown duration in refractory status epilepticus on a background of dementia, history of multiple falls, and indwelling foley catheter in addition to hypertension and bilateral knee replacement. EEG demonstrated abnormal discharges in the right anterior temporal region on a background of diffuse slowing, consistent with temporal encephalitis; MRI showed no acute intracranial abnormality. Urinalysis demonstrated moderate bacteria in the urine and blood cultures demonstrated presence of Staphylococcus epidermidis and Streptococcus anginosus. CSF was negative for HSV1 and HSV2 IgG and IgM, but Meningitis Film array panel demonstrated HSV-1. The patient failed to improve after 5 days of acyclovir and the family opted for inpatient hospice.
This case demonstrates the importance of multiple diagnostic methods, as reliance on MRI and CSF PCR alone would have missed this fulminant progression. Additionally, acyclovir is recommended over valacyclovir by the Antimicrobial Stewardship Program.