Più complex che simplex: implicazioni cognitive ed emotive dell'encefalite erpetica in età pediatrica

Herpes simplex encephalitis is a serious central nervous system infection in children, carrying a risk of cognitive and emotional sequelae. We describe the case of a previously healthy 4-year-old girl who presented to the emergency department with fever and a seizure, characterized by unresponsiveness, gaze deviation, and muscle spasms. While a CT scan was negative, laboratory tests revealed neutrophilic leukocytosis and mild hyponatremia; a lumbar puncture showed monocytic pleocytosis and the presence of red blood cells. Empirical therapy with acyclovir and ceftriaxone was initiated; cerebrospinal fluid (CSF) PCR testing subsequently confirmed HSV-1 infection, and a brain MRI revealed a necrotizing-haemorrhagic lesion in the left temporal lobe (involving the hippocampus, insula, and fornix). High-dose acyclovir therapy was continued for 21 days, alongside antiepileptic prophylaxis. Despite gradual neurological improvement, the patient continued to exhibit irritability, oppositional behaviour, and marked anomia—findings consistent with the temporal-limbic damage. This case highlights the long-term risk of cognitive-behavioural outcomes and post-encephalitic epilepsy, underscoring the importance of timely diagnosis and a multidisciplinary approach to care.