Organic Personality Disorder Following Mixed Sars-Cov-2 And Herpes Simplex Viral Encephalitis

We describe a 30-year-old functionally active male, who had sudden onset of fever, sever headache, altered sensorium followed by neck rigidity for 3 days duration. Nasopharyngeal swab for covid 19 was taken suspecting covid 19 encephalitis which turned out to be positive. CT brain revealed a hypodense lesion in the left anterior temporal lobe. CSF analysis showed lymphocytosis and elevated protein. RT-PCR of CSF detected HSV DNA. Patient was treated in an intensive care unit with intravenous antiviral drugs and was given oxygen support for hypoxemia. HIV was seronegative. After 2 weeks, there was significant alteration of the habitual pattern of premorbid behavior. Patient was brought to the psychiatric OPD with complaints of altered emotional behavior characterized by emotional lability, unprovoked aggression, reduced ability to persevere with goal directed activities and significant cognitive impairment. On MSE, patient has perseveration of speech, labile affect with no thought or perceptual disturbances. Combined infection of COVID 19 and HSV encephalitis is a rare entity, posing a dilemma of possible causative factor for the neuropsychiatric manifestation. Neuropsychiatric manifestations of HSV encephalitis include personality/behavioral change, seizures and cognitive impairment. No such recognized syndromes have been identified with covid 19 encephalitis except for delirium, depressive and anxiety states and post-traumatic stress disorder. The possible pathophysiology behind covid 19 encephalitis causing neuropsychiatric manifestation is immune/antibody mediated mechanism. Hence in this case, the contribution of SARS-CoV-2 causing such neuropsychiatric manifestation cannot be ruled out. REFERENCES: 1. A first case of meningitis/encephalitis associated with SARS-Coronavirus2 Takeshi Moriguchi 1, Norikazu Harii 2, Junko Goto 3, Daiki Harada 3, Hisanori Sugawara 3, Junichi Takamino 3, Masateru Ueno 3, Hiroki Sakata 3, Kengo Kondo 3, Natsuhiko Myose 3, Atsuhito Nakao 4, Masayuki Takeda 5, Hirotaka Haro 6, Osamu Inoue 7, Katsue Suzuki-Inoue 8, Kayo Kubokawa 9, Shinji Ogihara 10, Tomoyuki Sasaki 8, Hiroyuki Kinouchi 11, Hiroyuki Kojin 12, Masami Ito 12, Hiroshi Onishi 13, Tatsuya Shimizu 13, Yu Sasaki 13, Nobuyuki Enomoto 14, Hiroshi Ishihara 15, Shiomi Furuya 12, Tomoko Yamamoto 12, Shinji Shimada 16; 2. Postviral autoimmune encephalitis: manifestations in children and adults Harald Prüss 1.