Alterações de comportamento na encefalite herpética: Um caso polimórfico e de difícil manejo

Abstract

Herpes encephalitis is a high-mortality disease that must be quickly diagnosed and treated. Headache, fever and behavioral changes are the classic triad. There are few studies on the topic and none focus specifically on the management of psychiatric manifestations. The case report refers to 35-year-old patient who had those symptoms and was diagnosed and treated properly. One month later he showed disorganized behavior and agitation, and was readmitted. Herpes infection relapse was discarded, and he was transferred to the psychiatric ward, where he remained hospitalized for 116 days. During that time he became more agitated and even aggressive, and at one point began to undergo complex partial seizures. Electroencephalogram results were normal. Partial stabilization required six psychotropic drugs at high doses. At discharge he was no longer aggressive and his behavior was less disorganized, but he had poor memory, fragmented thinking, delusional interpretations, and latent impulsiveness. Case challenges: long-term hospitalization, risks, physical and emotional distress for patients, family, and health professionals. The final results show that an important, albeit partial, improvement may be achieved in a polymorphic case of herpetic encephalitis.