Diagnostic Dilemmas with Herpes Simplex Encephalitis

Clinical manifestations of herpes encephalitis range from minimal symptoms to hemorrhagic necrosis of the temporal lobes with high rates of morbidity (20% to 30%) and mortality (70%).3-5 Although brain biopsy is the definitive diagnostic procedure, the clinical presentation, along with temporal lobe abnormalities detected by electroencephalogram (EEG) and magnetic resonance imaging of the brain, can be highly suggestive of the diagnosis. Response to appropriate antiviral therapy gives further support to the proper diagnosis of HSV encephalitis. The following case of herpes encephalitis in a child with leukemia highlights diagnostic dilemmas associated with early recognition and therapy.