Case Report

Herpes Simplex Virus type 2 Encephalitis in an Elderly Immunocompetent Male

Authors: Matthew D. Reuter, MD, Farrin A. Manian, MD, Melissa A. Kershaw, DO, Martin A. Alpert, MD


An 85-year-old immunocompetent man was hospitalized following the development of increasing confusion and intermittent disorientation over a 48-hour period. Within 48 hours of hospitalization, he was oriented to person only and was unable to follow commands. There were no focal neurologic deficits. Magnetic resonance imaging of the brain showed extensive perivascular demyelination. Lumbar puncture was performed and showed normal opening pressure. Cerebrospinal fluid analysis showed 8 leukocytes (7 lymphocytes), as well as normal glucose and protein levels. Polymerase chain reaction evaluation of cerebrospinal fluid was positive for herpes simplex virus type 2. He was diagnosed with herpes simplex type 2 encephalitis and is to the authors’ knowledge the first elderly immunocompetent patient to be reported with this disorder.

Key Points

* Herpes simplex virus (HSV) type 2 encephalitis is less common and usually less severe than HSV type 1 encephalitis.

* HSV type 2 encephalitis has rarely been reported in the elderly and then only in older persons with impaired immunity.

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