ArticleMedicine2025
From acute stress syndrome to CNS infection: A case of HSV encephalitis with psychiatric mimicry.
Article in Medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Serum Aβ42 and hemoglobin as independent predictors of post-stroke cognitive impairment: a comparative biomarker study.Scientific reports · 2026Article
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Authors and funding
4 authors.
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Abstract
rationaleHerpes simplex virus type 1 (HSV-1) encephalitis is a rare but life-threatening central nervous system infection. Its early manifestations can mimic primary psychiatric disorders, which may delay recognition and treatment. We report a case where acute stress disorder masked underlying HSV-1 encephalitis. PATIENT CONCERNS: A 47-year-old male patient presented with acute emotional distress, anxiety, sleep disturbance, and dissociative symptoms following the sudden death of his young niece. DIAGNOSES: The patient initially fulfilled Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria for acute stress disorder without neurological signs. During hospitalization, he developed fever, confusion, and disorientation. A computed tomography scan was initially interpreted as normal; however, subtle temporal lobe hypodensities were noted by a medical trainee. A subsequent magnetic resonance imaging revealed temporal lobe hyperintensities. cerebrospinal fluid analysis showed lymphocytic pleocytosis, and polymerase chain reaction confirmed HSV-1, establishing the diagnosis of HSV-1 encephalitis.
interventionsThe patient was treated with intravenous acyclovir. OUTCOMES: The patient's fever and psychiatric symptoms improved, and he was discharged in stable condition after completing a 7-day course of antiviral therapy. At a 1-month follow-up, he showed no neurological or psychiatric sequelae. LESSONS: There are diagnostic challenges when psychiatric symptoms occur before neurological manifestations of HSV encephalitis. Clinicians should maintain a high index of suspicion for organic etiologies in atypical psychiatric presentations, and early neuroimaging and cerebrospinal fluid studies are essential to avoid delays in life-saving treatment.
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