Abstract
A 19-year-old, previously healthy unmarried girl presented with sudden onset loss of consciousness preceded by genital ulcers, fever and headache. Examination revealed mild neck stiffness, 4/15 of GCS, and upper motor neuron signs in all four limbs. In addition, there were multiple, superficial and tender genital ulcers. Electro Encephalogram (EEG) showed evidence of encephalitis and subsequent serological tests revealed presence of HSV antibodies. Her condition improved remarkably following intravenous Aciclovir therapy. Presence of typical herpetic ulcers, positive type specific serology test for HSV, evidence of encephalitis in the EEG and good response to Aciclovir, favoured the possible diagnosis of Herpes Simplex Encephalitis (HSE). Sri Lanka Journal of Sexual Health and HIV Medicine Vol.1 2015: 29-32
Highlights
Herpes simplex virus (HSV) infection is one of the commonest causes for genital ulcers [1]
There are about 530 million people living with Herpes Simplex Virus (HSV 2) [2]
Initial management was done at the medical ward and 3 days after hospital admission, she was referred to the STD clinic. Her Glasgow Coma Scale (GCS) was 4/15, upper motor neuron signs were noted in all four limbs and mild neck stiffness was present at the initial examination
Summary
Herpes simplex virus (HSV) infection is one of the commonest causes for genital ulcers [1]. Her Glasgow Coma Scale (GCS) was 4/15, upper motor neuron signs were noted in all four limbs and mild neck stiffness was present at the initial examination Her full blood count showed elevated white blood cell count (11,300cells/μl) and ESR was 62mm/hr. According to mother there was no associated photophobia, drowsiness, change in behaviour or seizures before loss of consciousness She never had oral or genital ulcers in the past. The patient was discharged from the ward after completing the intravenous aciclovir for 14 days By that time, she was conscious and oriented but had slurring of speech, motor responses slow and poor memory.
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