Case Report ACaseofHerpesSimplexVirus-1EncephalitisfromaMedicolegal Point of View Alessandro Feola , 1 Anna Mancuso, 1 and Mauro Arcangeli 2 1 Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy 2 Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy Correspondence should be addressed to Alessandro Feola; alessandro.feola@icloud.com Received 25 January 2018; Accepted 26 April 2018; Published 10 June 2018 Academic Editor: Benedetto Bruno Copyright © 2018 Alessandro Feola et al. is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. We present a case of herpes simplex virus-1 encephalitis (HSVE) and discuss the difficulty of early diagnosis and the possibility of a wrong or delayed diagnosis and treatment of this encephalitis. We show the importance of considering HSVE to pursue every case of suspicious medical liability. 1. Introduction Herpes simplex virus-1 (HSV-1) encephalitis (HSVE) is a rare viral infection of the human central nervous system (CNS) entailing neurological dysfunction. However, it is the commonest infectious cause of sporadic encephalitis. e annual incidence of HSVE worldwide is estimated to be 1–4 cases/1,000,000 [1, 2]. HSVE has a bimodal age distribution, with peak in- cidences in children less than 3 years old and those aged 50 years or more. Most cases occur in subjects older than 50 years of both sexes. HSVE is difficult to diagnose and has a poor prognosis. Morbidity and mortality are greater if treatment is delayed or inadequate. In these cases, there could be medicolegal consequences, particularly legal lia- bility for medical malpractice and nervous system injury assessment. We report the case of a 60-year-old man with HSVE. 2. Case Presentation A 60-year-old diabetic patient with chronic kidney disease, and treatment with corticosteroids for nephrotic syndrome, came into our emergency room. He presented with fever, dyspnea, and disorientation and was in a fugue state with naming difficulties and aphasia. A complete blood count showed a white blood cell count of 14,630/ml and his C-re- active protein was 1.2 mg/dl (normal range, 0–0.5 mg/dl). A computed tomographic scan was negative for brain injury. Cerebrospinal fluid (CSF) tests were positive: the fluid was turbid, glycorrhachia was 141mg/dl (normal range, 50–80mg/dl), proteinorrachia was normal, and the CSF white cell count was 135/UI (normal range, 0–5/UI) with a left shift (90% neutrophils and 10% lymphocytes). e patient was given broad-spectrum antibiotic therapy while awaiting the CSF culture results. Two days later, the patient was co- matose, with right hemiplegia. He did not obey simple com- mands and opened his eyes only after painful stimulation. e CSF culture was negative for bacteria, but viral DNA corre- sponding to HSV-1 was detected in the fluid. Magnetic res- onance imaging detected diffuse signal changes in the cortical and subcortical matter, especially in the frontal-temporal re- gion and the parietal region in both cerebral hemispheres, but particularly in the left hemisphere. Doctors diagnosed herpetic encephalitis. ey prescribed acyclovir treatment at a dose of 750 mg/250 ml in 3 h three times a day for 21 days because the patient’s glomerular filtration rate ranged from 10 ml/min to 50 ml/min. e patient was moved to a rehabilitation facility after 21 days. At discharge from the rehabilitation facility, the patient had a percutaneous endoscopic gastrostomy (PEG) Hindawi Case Reports in Medicine Volume 2018, Article ID 3764930, 3 pages https://doi.org/10.1155/2018/3764930