Diagnosis of suid herpesvirus encephalitis using next-generation sequencing: A case report

Rationale: The diagnosis of viral encephalitis by conventional and biochemical results of lumbar puncture of cerebrospinal fluid (CSF) is common in neurology, but the diagnosis of specific pathogens has benefited from the improvement of CSF diagnosis technology. Second-generation sequencing allows for more sensitive and accurate pathogen detection. A case of suid herpesvirus encephalitis was reported here. Patient concerns: A 35-year-old male experienced severe right head pain and intermittent right upper limb convulsions, occurring approximately 10 times daily since January 7, 2019. He was suddenly losing consciousness, with twitching limbs, eye movement, trismus, foaming at the mouth, and urinary incontinence, lasting 10 minutes/episode. On January 10, 2019, the patient was transferred to the intensive care unit because of epilepsy symptoms were not well controlled, and the highest temperature reached 39°C. The patient had a history of blood contact while handling raw pork, resulting in scratched and bleeding fingers before the illness began. Diagnoses: Diagnostic tests revealed elevated neutrophils, low lymphocytes, high erythrocyte sedimentation rate, low free triiodothyronine levels, and high creatinine kinase. Cranial magnetic resonance imaging showed abnormalities in various brain regions, mainly affecting the gray matter structures of the cortex. CSF analysis detected suid herpesvirus-1 as the infection source. Interventions: Treatment included mannitol, sodium valproate, acyclovir, foscarnet sodium, and nutritional support. Outcomes: After 1.5 months, the patient gradually regained consciousness but remained with visual impairment and paralysis. Lessons: Patients with pork contact and clinical, laboratory, and imaging examinations suggesting viral encephalitis should be considered to have suid herpesvirus encephalitis, which can be confirmed by next-generation sequencing.