Great job! This was a tricky case because it really required us to recognize that not all tests are perfect, and to always go back to our overall formulation of patients' presentations. Diagnosis of HSV encephalitis is so important given its high morbidity and mortality. (Sadly, even with timely diagnosis, mortality is still high.) If the second HSV PCR was also negative, then we would've changed direction and evaluated for other possible etiologies.
We might not be able to extrapolate this to floor patients based on the 2022 study's population. However, the key point to recognize is that this value is non-zero, and that this patient had impressive radiographic and consistent electrographic findings that, in total, still suggested HSV encephalitis.
Continuing with the theme that no test is perfect, it's important for us to recognize that we can't totally rely on the CSF WBC count to guide our antimicrobial decision-making. Again, this patient had impressive radiographic and consistent electrographic findings that, in total, still suggested HSV encephalitis.
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