Intensive Care Management of a Patient with Comorbidity of Pneumonia and Herpetic Encephalitis

A self-sufficient 77-year-old patient with no systemic disease other than type 2 diabetes mellitus and hypertension sought treatment at a private medical center because she gave inconsistent and nonsensical responses to relatives and developed confusion. Cranial magnetic resonance imaging showed acute cytotoxic edema. Patient was transferred to emergency unit with high fever and right lower extremity jerking. Examination of cerebrospinal fluid (CSF) revealed positive polymerase chain reaction for herpes simplex virus type 1, and based on diagnosis of viral encephalitis, acyclovir therapy was initiated. On the fourth day of follow-up in the neurology clinic, the patient was orotracheally intubated and admitted to intensive care unit (ICU) because of respiratory distress and loss of consciousness. Thoracic computed tomography revealed atelectasis and air bronchogram in the right lung, which indicated pneumonia. On the seventh day in the ICU, the patient was able to opened her eyes spontaneously and follow commands. Weaning from mechanical ventilation was initiated and the patient was discharged home with cure on the sixteenth day of admission. Detection of virus in CSF analysis, prompt administration of antiviral therapy and ICU support ensured rapid recovery without any residual sequelae in this case of herpes simplex encephalitis.