30 November 2025
: Case report 
Afebrile HSV-2 Encephalitis with Radiographic Atypia and Minimal Systemic Inflammation: A Case Report
Unusual clinical course, Challenging differential diagnosis
Shunsuke Kondo
ABDEF 1*, Wejdan Abo Qayas EF 2, Osama Hasan EF 1, Rachel Haide N. Tacata E 3, Matthew W. Kobylinski EF 1, Lorrance Majewski E 4
DOI: 10.12659/AJCR.950444
Am J Case Rep 2025; 26:e950444
Table 1 Laboratory data on admission.
| WBC | 8970 | /μL |
| Neu | 57.4 | % |
| Eos | 1.7 | % |
| Lym | 24.5 | % |
| Hb | 10.9 | g/dL |
| Hct | 36.9 | % |
| Plt | 13.8×10 | /μL |
| T-Bil | 10.0 | mg/dL |
| D-Bil | 6.7 | mg/dL |
| AST | 63 | U/L |
| ALT | 18 | U/L |
| ALP | 206 | U/L |
| BUN | 7.0 | mg/dL |
| Cre | 0.6 | mg/dL |
| Na | 130 | mEq/L |
| K | 2.7 | mEq/L |
| Cl | 97 | mEq/L |
| Glucose | 156 | mg/dL |
| Lactic acid | 8.7 | mEq/L |
| Magnesium | 1.4 | mEq/L |
| Ammonia | 131 | μmol/L |
| Ethanol | – | |
| CRP | 4.42 | mg/L |
| ANA | 160 | |
| C3 | 56 | mg/dL |
| C4 | 4 | mg/dL |
| CH50 | 22 | |
| RF | 16 | IU/mL |
| P-ANCA | – | |
| C-ANCA | – | |
| Anti-SSA antibody | – | |
| Anti-SSB antibody | – | |
| PT-INR | 1.9 | |
| APTT | 36.5 | s |
| SARS-CoV-2 PCR | – | |
| Influenza A/B antibody | – | |
| HIV-1/2 antibody | – | |
| Blood culture | – | |
| Urine toxicology | – | |
| Urine hCG | – | |
| WBC – white blood cells; Neu – neutrophils; Eos – eosinophils; Lym – lymphocytes; Hb – hemoglobin; Hct – hematocrit; Plt – platelets; T-Bil – total bilirubin; D-Bil – direct bilirubin; AST – aspartate aminotransferase; ALT – alanine aminotransferase; ALP – alkaline phosphatase; BUN – blood urea nitrogen; Cre – creatinine; CRP – C-reactive protein; ANA – antinuclear antibody; C3 – complement 3; C4 – complement 4; CH50 – 50% hemolytic complement activity; RF – rheumatoid factor; P-ANCA – perinuclear antineutrophil cytoplasmic antibody; C-ANCA – cytoplasmic antineutrophil cytoplasmic antibody; Anti-SSA – anti-Sjögren’s syndrome A antibody; Anti-SSB – anti-Sjögren’s syndrome B antibody; PT-INR – prothrombin time-international normalized ratio; APTT – activated partial thromboplastin time; SARS-CoV-2 – severe acute respiratory syndrome coronavirus 2; PCR – polymerase chain reaction; HIV – human immunodeficiency virus; hCG – human chorionic gonadotropin. | ||