Herpes Simplex Encephalitis in Older Adults

Riera‐Mestre, Antoni; Requena, Ana; Martínez-Yélamos, Sergio; Cabellos, Carmen; Fernández-Viladrich, P

doi:10.1111/j.1532-5415.2009.02655.x

Cited by 7 publications

(4 citation statements)

References 8 publications

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“…Even in elderly and immunocompromised patients, fever is usually present in HSE [ 6 , 8 , 9 ]. Afebrile HSE is rare [ 2 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

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Herpes simplex encephalitis initially presenting without fever or cerebrospinal fluid pleocytosis and with typical neuroimaging findings: a case report

Na,

Lee,

Kim

et al. 2024

encephalitis

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Herpes simplex encephalitis (HSE) is a common viral encephalitis that can be fatal if not adequately treated. Fever, cerebrospinal fluid (CSF) pleocytosis, and typical neuroimaging findings are commonly observed in HSE cases. We encountered a patient with HSE who did not exhibit these classic clinical features. A 63-year-old male presented with his first-ever seizure. Fever did not develop until the fourth day of admission, and neither neuroimaging nor CSF analysis revealed abnormalities. Under suspicion of autoimmune encephalitis, methylprednisolone was administered. Subsequently, when the patient developed fever, a follow-up neuroimaging study was performed and revealed abnormalities consistent with HSE. The patient was promptly treated with acyclovir, which led to a full recovery. Diagnosing HSE in patients who present without fever or CSF pleocytosis and with typical neuroimaging findings poses a challenge. Therefore, prior to initiating immunosuppressive treatment, it is crucial to closely observe patients and to conduct follow-up tests, including neuroimaging and CSF analysis.

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“…Even in elderly and immunocompromised patients, fever is usually present in HSE [ 6 , 8 , 9 ]. Afebrile HSE is rare [ 2 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…Even in elderly and immunocompromised patients, fever is usually present in HSE [ 6 , 8 , 9 ]. Afebrile HSE is rare [ 2 , 8 ]. Our case did not exhibit any immunological abnormalities and had not taken any medication that could affect the immunological system.…”

Section: Discussionmentioning

confidence: 99%

Herpes simplex encephalitis initially presenting without fever or cerebrospinal fluid pleocytosis and with typical neuroimaging findings: a case report

Na,

Lee,

Kim

et al. 2024

encephalitis

View full text Add to dashboard Cite

show abstract

“…Despite HSE having a bimodal age distribution (patients below 20 years of age or above 50 with the peak between 60 and 64 years), only few data have been reported about HSE in older adults. [910] In a series of 12 elderly HSE patients, outcome was poor and mortality was high than in patients with HSE in general. [10] Major symptoms observed in this series had been behavioral changes and disorientation as in patient 2.…”

Section: Discussionmentioning

confidence: 99%

“…[910] In a series of 12 elderly HSE patients, outcome was poor and mortality was high than in patients with HSE in general. [10] Major symptoms observed in this series had been behavioral changes and disorientation as in patient 2. These symptoms are common in various disorders in older patients and can easily be misdiagnosed.…”

Section: Discussionmentioning

confidence: 99%

Pitfalls associated with the diagnosis of herpes simplex encephalitis

Vachalová

Kyavar

Heckmann

2013

Journal of Neurosciences in Rural Practice

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Herpes simplex encephalitis (HSE) still remains a serious illness with high morbidity and mortality. The characteristic presentation of HSE usually consists of fever, headache, and altered mental function. We present three patients with atypical features of HSE. First, a 48-year-old man with symptomatic posttraumatic epilepsy, who developed a gastrointestinal infection, seizures, and fever. After significant clinical improvement, the patient had fever again and developed a status epilepticus, which led to the diagnosis of HSE. Second, an 84-year-old woman with hyperactive delirium after levofloxacin intake. Cranial computed tomography (CCT) revealed hypodense temporal changes, prompting lumbar puncture and diagnosis of HSE. Third, a 51-year-old diabetic woman presented with fever and acute confusion. As CCT and cell count of cerebrospinal fluid (CSF) were normal, infection and hyperglycemia as initial diagnoses were postulated. Due to aphasic symptoms, the differential diagnosis of a stroke was taken into account. Thus a second lumbar puncture led to the correct diagnosis of HSE. These atypical presentations need a high grade of suspicion and a high willingness to reconsider the initial working diagnosis, in order to prevent a diagnostic delay.

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Diagnostic Methods and Management Strategies of Herpes Simplex and Herpes Zoster Infections

Frisch

Guo

2013

Clinics in Geriatric Medicine

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Herpes Simplex Encephalitis in Older Adults

Cited by 7 publications

References 8 publications

Herpes simplex encephalitis initially presenting without fever or cerebrospinal fluid pleocytosis and with typical neuroimaging findings: a case report

Herpes simplex encephalitis initially presenting without fever or cerebrospinal fluid pleocytosis and with typical neuroimaging findings: a case report

Pitfalls associated with the diagnosis of herpes simplex encephalitis

Diagnostic Methods and Management Strategies of Herpes Simplex and Herpes Zoster Infections

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