A 23-year-old Caucasian male with a past medical history of anxiety, pilonidal cyst removal from the lower back in 2 years ago, and EBV infection 1 month ago presents to an on-campus eye institute after 1 week of binocular diplopia, headache, intermittent muscle weakness, neck soreness, and nausea. Patient symptoms concerning for internuclear ophthalmoplegia or multiple sclerosis, so the patient was further evaluated at the emergency room. A brain MRI revealed a temporal lobe hyperdensities concerning for HSV encephalitis. A lumbar puncture was performed, and CSF analysis supported a viral etiology but HSV PCR was negative. Patient was provided solumedrol and acyclovir treatment with plans to repeat lumbar puncture further into treatment to assess for HSV again. Serology revealed negative MOG IgG and positive NMO IgG. With CSF WBC elevation, clinical picture and serology being consistent with neuromyelitis optica as the diagnosis, antiviral treatment was discontinued and steroid treatment was continued outpatient with prednisone.
What will audience learn from your presentation?
- Attendees will understand the similar yet different clinical presentation of HSV encephalitis, Multiple Sclerosis, and Neuromyelitis Optica
- Attendees will understand the diagnostic work-up required for HSV encephalitis, Multiple Sclerosis, and Neuromyelitis Optica
- Attendees will understand the treatment regimen for Neuromyelitis Optica
- Faculty will be ablet to utilize this information about HSV encephalitis, Multiple Sclerosis, and Neuromyelitis Optica in lectures for medical students, residents, fellows, peer-physicians and other healthcare professionals