A 38-year-old woman presents with 4 days of fever, behavioral change, and two witnessed focal seizures with head deviation to the right. MRI brain shows T2 hyperintensity and hemorrhage in the left medial temporal lobe and insular cortex. CSF shows lymphocytic pleocytosis with 40 cells per microliter. What is the most appropriate immediate management?
- A Oral valacyclovir 1 g three times daily
- B Intravenous acyclovir 10 mg/kg every 8 hours ✓
- C Intravenous ganciclovir plus foscarnet
- D High-dose corticosteroids and antituberculous therapy
Correct answer: B. Intravenous acyclovir 10 mg/kg every 8 hours
Explanation
Medial temporal and insular involvement with hemorrhagic change in an adult with fever, seizures, and encephalopathy is the classic pattern of herpes simplex virus type 1 encephalitis. Empirical intravenous acyclovir must be started immediately without waiting for PCR confirmation because mortality rises sharply with delayed treatment. Oral valacyclovir does not achieve adequate CNS levels, and the ganciclovir and foscarnet combination is used for cytomegalovirus encephalitis.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.