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A 60-year-old woman was admitted in the emergency room with acute onset of fever, altered mental status, and movement disorder. The patient had well-controlled type 2 diabetes mellitus with hemoglobin A1c up to 6.0%. In addition, neither steroids nor immunosuppressive agents had been taken. Brain magnetic resonance imaging (MRI) was shown in Fig. 1. What is the diagnosis?
Fig. 1Magnetic resonance imaging showing asymmetrical signal abnormality in the left mesial temporal lobe (A: fluid-attenuated inversion recovery sequences, B: diffusion-weighted imaging).
The abovementioned clinical and radiographic findings suggested herpes simplex virus (HSV) encephalitis. Immediately, lumber puncture was performed, and empirical treatment with acyclovir was initiated. Since HSV polymerase chain reaction (PCR) was positive in the cerebrospinal fluid (CSF), the diagnosis was confirmed. Three weeks later, the patient recovered.
Acute encephalitis is a neurological emergency which can cause severe impairment or death. HSV is the most common infectious cause of sporadic encephalitis [
]. Typical findings on MRI are asymmetrical hyperintensities on T2-weighted sequences in the mesiotemporal and orbitofrontal lobes and the insular cortex [
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