Encefalitis herpética crÓnica y alcoholismo. Caso clínico y revisiÓn de la bibliografía

Chronic Herpetic Encephalitis (CHE) is an entity of recent description, atypical in its presentation and evolution, that is treated according to the antiviral schemes described for severe cases; being still unknown the criteria for its cure, the serology and cerebrospinal fluid (CSF) evolution. We describe a case of CHE in a patient with a history of chronic alcoholism, that went into hospital with confusion, agitation, auditive and visual allucinations, with weight loss and generalized hypereflexia and no meningeal signs, motor nor sensitive focus. A lung infiltration was diagnosed as tuberculosis and anti-HIV was negative. The CSF presents no abnormality, with indian ink, direct examination, culture for bacteria and acid fast bacilli smear negative. A CT-scan without contrast showed diffuse cortical atrophy. The patient present generalized tonic-clonic seizures, horizontal nistagmus, ataxy and agitation and was treated as possible Wernicke encephalopathy, but remains confused, with global alteration of memory, allucinations and emotional lability. Twenty days after being hospitalized we received a positive nested PCR for herpes simplex type 1 in CSF, starting 30 mg ofAcyclovir per day. After 15 days of treatment he has a notorious neurological improvement, with persistence of positive PCR in CSF. A year latter, the PCR in CSF was negative for herpes simplex. This entity should be considered within the differential diagnosis in patients with persistent neurological deterioration, even though there might persist other factors that justify clinic compromise.