Herpes Simplex Encephalitis in a Patient With Lymphoma

Abstract

HERPES simplex encephalitis (HSE) is the most common cause of fatal sporadic encephalitis. 1 Recognition of this entity has become increasingly important with the advent of effective antiviral therapy. Clinical studies with vidarabine, and then with acyclovir sodium, See also pp 1051,1054, and 1067. treatment have supported a ten-day course of therapy as the standard duration. We recently cared for a patient who calls into question the adequacy of this regimen for the immunocompromised patient. Report of a Case A 58-year-old right-handed man presented in October 1986 with a one-day history of fever, confusion, and speech difficulty. Eighteen months previously he had been diagnosed with stage III, diffuse, poorly differentiated lymphocytic lymphoma; he had received chemotherapy, with minimal response, until six months before this hospitalization. On admission, his temperature was 38.6°C. The patient was disoriented to place and time; he was able to follow simple commands, but recall was poor.