Atypical case of Herpes simplex encephalitis.

摘要

A 67-year-old man presented with confusion and drowsiness that had developed over the course of that afternoon. This was associated with a mild frontal headache. He had taken oxycodone earlier that day for hip pain.His history included metastatic colon cancer, for which he finished the last cycle of adjuvant chemotherapy 4 weeks before presentation. He also had diabetes mellitustype 2.He was hospitalized on day 1 and was noted to be febrile to 39.5deg C and disoriented. He had mild neck stiffness. Theexamination was otherwise normal. Initial investigations showed a normal full blood count, normal electrolytes, moderately increased blood glucose, mildly increased liver enzymes, normal C-reactive protein (CRP) and normal urine. His chest radiograph and magnetic resonance imaging (MRI) head were normal. Cerebrospinal fluid (CSF) showed an increased protein of 900 mg/L, increased glucose of 6.0 mmol/L, but normal cell counts. Further testing for organisms and cytology was requested. Empirical antibiotics covering bacterial meningitis were commenced.