Ehret Jane, Al Safi Ali, Akabusi Chika, Ajibola Oluwafemi, Kung David
Internal Medicine, Nuvance Health at Vassar Brothers Medical Center, Poughkeepsie, USA.
Critical Care Medicine, Nuvance Health at Vassar Brothers Medical Center, Poughkeepsie, USA.
Cureus. 2022 Apr 18;14(4):e24255. doi: 10.7759/cureus.24255. eCollection 2022 Apr.
Herpes simplex virus (HSV) encephalitis is the most common cause of nonendemic sporadic encephalitis in the United States. Treatment with acyclovir has been proven to reduce mortality by 50%. Antiviral therapy should be initiated immediately in patients with clinical suspicion of viral encephalitis and should not be delayed by serological confirmation of the diagnosis. The most common central nervous system complication of HSV encephalitis is seizures (38%), while intracranial hemorrhage is very rare (2.7%). We describe a case of a 59-year-old African American male who presented to the hospital after being found unresponsive for a day and was found to have HSV-1 encephalitis that was complicated by hemorrhagic conversion. Our patient's neurological status did not improve even with appropriate antiviral treatment with a 28-day course of intravenous (IV) acyclovir. Intracranial hemorrhage is a rare complication in patients with HSV encephalitis. Close monitoring of neurological status is recommended for signs of deterioration or lack of improvement, and further imagings are needed (as in our patient) to evaluate for neurological complications such as intracranial hemorrhage.
单纯疱疹病毒（HSV）脑炎是美国非地方性散发性脑炎最常见的病因。已证实使用阿昔洛韦治疗可使死亡率降低50%。对于临床怀疑为病毒性脑炎的患者应立即开始抗病毒治疗，不应因血清学确诊诊断而延迟。HSV脑炎最常见的中枢神经系统并发症是癫痫发作（38%），而颅内出血非常罕见（2.7%）。我们描述了一例59岁非裔美国男性病例，该患者在被发现无反应一天后入院，被诊断为HSV-1脑炎并伴有出血性转化。即使给予28天疗程的静脉注射阿昔洛韦进行适当的抗病毒治疗，我们这位患者的神经状态仍未改善。颅内出血是HSV脑炎患者中罕见的并发症。建议密切监测神经状态，以发现恶化或无改善的迹象，并且需要进一步的影像学检查（如我们的患者）来评估诸如颅内出血等神经并发症。
