Post-Herpetic Autoimmune Encephalitis

Excerpt

To the Editor: A previously healthy 8-y-old boy presented with fever, generalized seizures, and progressive lethargy for the past 4 d. On examination, he had altered sensorium, meningismus, and brisk muscle stretch reflexes. There were no focal motor deficits or papilledema. A clinical diagnosis of acute meningoencephalitis was considered. Cerebrospinal fluid examination showed 268 cells (74% lymphocytes), normal glucose, elevated protein (217 mg%), absence of red blood cells and positive Herpes simplex virus (HSV)-DNA PCR. The magnetic resonance imaging (MRI) brain was suggestive of changes seen in herpes encephalitis (Fig. 1). Electroencephalograph showed bilateral slowing with no epileptiform discharges. Intravenous acyclovir (60 mg/kg/day) was administered for 21 d. At discharge, he had residual cognitive and speech impairment.

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