Herpes encephalitis with psychiatric symptoms and cognitive impairment are reported previously. We report a case of herpes encephalitis who had delirium, psychosis and depressive disorder respectively during the acute encephalitis and post encephalitic term.
A 27 years old man, who was hospitalized by microbiology clinic, diagnosed with herpes encephalitis by PCR. The MRI study showed high-signal areas in bilateral temporal lobes. He had delirium symptoms during acute encephalitis so a low-dosage of Haloperidole was added to herpes treatment. Delirium symtoms recovered in a few days. 2 months after discharge he admitted to psychiatry outpatient clinic with the complaints of irritability and hipomnesia. In psychiatric examination; delusions, hallucinations, aggression, disorganized behavior were found, postencephalitic lesions in bilateral temporal lobes and abscess formation in left hippocampus secondary to encephalitis determined by repeated MRI. At the neurupsychiatric evaluation; deficits in verbal-episodic memory, visuoperceptual functions and disorientation were present. Olanzapine was started and titrated up to 20 mg/day. His psychotic symptoms recovered but few mounts later depressive symptoms especially feelings of insufficiency occurred. Olanzapine was gradually decreased; simultaneously Sertralin was started and titrated up to 150 mg/day. The following MRI studies showed a recovery in the counts and sizes of abscess formations. At the end of one year depressive symptoms and cognitive impairment continued with a partial recovery.
The pathologic changes and alterations including bilateral temporal lobes and hippocampus may be responsible for the occurrence and variety of symptoms in this case so it highlights the relationship between psychiatric disorders and different brain regions.