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LETTERS TO THE EDITOR
2. Fermand JP, Brouet JC, Danon F, et al. Gamma heavy chain “disease”: Heterogeneity of the clinicopathologic features. Report of 16 cases and review of the literature. Medicine (Baltimore) 1989;68:321–335.
ABSENCE OF PLEOCYTOSIS IN CEREBROSPINAL FLUID DOES NOT EXCLUDE HERPES SIMPLEX VIRUS ENCEPHALITIS IN ELDERLY ADULTS To the Editor: Herpes simplex virus encephalitis (HSVE) is the most-common cause of viral encephalitis in developing countries. HSVE is a medical emergency, and diagnosis is essential to reduce mortality and morbidity. Diagnosis is definitely established by the detection of viral deoxyribonucleic acid using polymerase chain reaction (PCR) in the cerebrospinal fluid (CSF). Initial CSF examination is nearly always abnormal and discloses pleocytosis. Two individuals who presented with HSVE confirmed using PCR despite lack of CSF pleocytosis are reported here.
CASE REPORT Patient 1 A 90-year-old man was referred for a fall with right shoulder trauma. His medical history included hypertension, dyslipidemia, and moderate chronic renal failure due to nephroangiosclerosis. At admission, he had a fever (39.9°C) and was confused. He had no neurological focal signs. Brain computed tomography (CT) was unremarkable. Blood tests revealed inflammation, with a high C-reactive protein level (39.9 mg/L; normal
LETTERS TO THE EDITOR
2. Fermand JP, Brouet JC, Danon F, et al. Gamma heavy chain “disease”: Heterogeneity of the clinicopathologic features. Report of 16 cases and review of the literature. Medicine (Baltimore) 1989;68:321–335.
ABSENCE OF PLEOCYTOSIS IN CEREBROSPINAL FLUID DOES NOT EXCLUDE HERPES SIMPLEX VIRUS ENCEPHALITIS IN ELDERLY ADULTS To the Editor: Herpes simplex virus encephalitis (HSVE) is the most-common cause of viral encephalitis in developing countries. HSVE is a medical emergency, and diagnosis is essential to reduce mortality and morbidity. Diagnosis is definitely established by the detection of viral deoxyribonucleic acid using polymerase chain reaction (PCR) in the cerebrospinal fluid (CSF). Initial CSF examination is nearly always abnormal and discloses pleocytosis. Two individuals who presented with HSVE confirmed using PCR despite lack of CSF pleocytosis are reported here.
CASE REPORT Patient 1 A 90-year-old man was referred for a fall with right shoulder trauma. His medical history included hypertension, dyslipidemia, and moderate chronic renal failure due to nephroangiosclerosis. At admission, he had a fever (39.9°C) and was confused. He had no neurological focal signs. Brain computed tomography (CT) was unremarkable. Blood tests revealed inflammation, with a high C-reactive protein level (39.9 mg/L; normal
