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 3 Clinical course during hospitalization.
| Day | Event |
|---|---|
| 1 | Symptom onset (left-sided numbness and seizure), arrival at emergency department, brain MRI performed |
| 2 | Lumbar puncture performed |
| 3 | CSF PCR showed HSV-2 positivity; empiric antiviral treatment initiated |
| 5 | Second seizure; hepatic encephalopathy suspected; lactulose regimen intensified |
| 3–21 | Continued intravenous acyclovir |
| 21 | Discharged clinically stable to a skilled nursing facility to complete intravenous acyclovir treatment |
| MRI – magnetic resonance imaging; CSF – cerebrospinal fluid; PCR – polymerase chain reaction; HSV – herpes simplex virus. | |