An unusual late complication of intracerebral haematoma in herpes encephalitis after successful acyclovir treatment

This is a case report of PCR proven herpes simplex (HSV-1) encephalitis in a 26 years old immunocompetent adult taking an unusual course of acute intracerebral haematoma after successful and complete recovery with acyclovir therapy. This transient late complication was associated with a negative repeat CSF PCR for HSV suggesting that the initial 14 days course of acyclovir was successful in the eradication of the herpes virus infection as recommended by the International Herpes Management Forum (IHMF). The location of the haematoma corresponded to the initial encephalitic area involving the medial temporal lobe structures. Despite this late neuroradiologic complication, after day 18 of symptom onset, the patient had a favourable neurological outcome. To the best of our knowledge, this is the second report of the unusual, rare, and late neuroimaging complication of acute intracerebral haematoma formation after complete recovery from treated HSVE with favourable clinical outcome. The literature is reviewed and plausible aetiology is discussed.