# A Case of Fatal Herpes Simplex Virus 1 Encephalitis Complicated by Status Epilepticus: From Elective Phlebectomy to Intensive Care

## TL;DR

A 73-year-old woman developed severe brain inflammation from HSV-1, leading to rapid health decline and intensive care.

## Contribution

This case report highlights the rapid progression and complications of HSV-1 encephalitis in an elderly patient.

## Key findings

- HSV-1 encephalitis was confirmed via MRI and cerebrospinal fluid analysis.
- The patient's condition rapidly deteriorated with obtundation and high-grade fever.
- The case emphasizes the challenges in managing HSV-1 encephalitis with poor prognosis.

## Abstract

Herpes simplex encephalitis is most commonly caused by herpes simplex virus type 1 (HSV-1) and is believed to result from retrograde transport along the trigeminal and olfactory nerves into the central nervous system. This case report presents a 73-year-old female who arrived at the emergency department following the acute onset of confusion before an elective outpatient procedure. Her initial physical examination and diagnostic workup were unremarkable. By day six of hospitalization, the patient became progressively obtunded, with significant clinical deterioration marked by a Glasgow Coma Scale score of 5 and recurrent episodes of high-grade fever. Magnetic resonance imaging revealed inflammation and hyperintensities in the right frontotemporal lobes, highly suggestive of HSV encephalitis, and cerebrospinal fluid analysis confirmed HSV-1 infection. This case report discusses the rapid clinical progression of HSV-1 encephalitis, highlights potential complications, and reviews the acute management of a patient with a poor prognosis.