METHODS (DIFFERENTIAL DIAGNOSIS, INVESTIGATIONS AND TREATMENT)
Diagnostic workup included imaging and CSF studies. At the first center,
CSF analysis results indicated a viral etiology, characterized by total
leucocyte count – 10 per high power field constituted by 98%
lymphocytes with sugar level – 20 mg/dl, elevated protein - 79 mg/dl
and normal ADA.
Computed Tomography scan at the second center revealed bilateral
asymmetric hypodensities, predominantly on the left side, affecting the
cortex, antero-inferior temporal lobe, and infero-lateral lobes. Repeat
lumbar puncture report was positive for both Herpes Simplex Virus (HSV)
and Epstein-Barr Virus (EBV) confirmed with polymerase chain reaction.
MR Imaging at our center revealed ill-defined T2/FLAIR lesions in the
bilateral insular cortex, bilateral superior temporal gyri, and
bilateral precentral gyrus involving both grey and white matter of
frontoparietal lobes (left > right), features that were
suggestive of sequelae of Fiox-Chavany-Marie syndrome secondary to
herpes simplex encephalitis.
Antiviral therapy (Acyclovir- 500 mg intravenous three times a day) was
initiated at the second center where CSF-PCR showed Herpes simplex,
which was continued at our center covering total duration of 28 days. A
tracheostomy tube was electively inserted to facilitate respiratory
support. Besides antiviral therapy, other supportive treatments were
given to address complications such as hospital-acquired pneumonia and
respiratory distress.