A 78-year-old woman was admitted to our ICU with the clinical picture of herpes simplex encephalitis (HSE). We started treatment with acyclovir but rejected this diagnosis after two
negative HSV-1/-2 PCRs on cerebrospinal fluid (CSF), obtained on day 2 and 5. Our patient initially improved, but showed neurological deterioration again after 21 days. To our surprise, a third HSV-1 PCR on CSF obtained on day 23 was positive. Acyclovir was restarted, but she did not recover and died on day 37. HSE is a severe neurological disease, with high mortality and morbidity. Early recognition, diagnosis and appropriate treatment (acyclovir 10 mg/kg x3/day for 14-21 days) are of upmost importance to provide the patient with the best chance of recovery. It is very important to keep in mind the possibility of multiple negative PCR results.
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