Rathi report details Hsv-1 case with 23-year-old woman
A case report by Pratik Rathi and coauthors describes a 23-year-old woman with hsv-1-positive anti-NMDAR encephalitis that first looked like a primary psychiatric disorder. The report says she developed behavioural changes and altered sensorium before cerebrospinal fluid testing and real-time PCR pointed to the underlying cause.
Pratik Rathi case report
The article, cited on June 16, 2026 in Cureus 18: e110962, centers on a diagnosis that can begin with psychiatric manifestations, seizures, dyskinesias, autonomic instability, and altered consciousness. Anti-N-methyl-D-aspartate receptor encephalitis is described in the report as a severe form of autoimmune encephalitis, and herpes simplex virus encephalitis is recognised as a major cause of secondary autoimmune encephalitis.
That combination shaped the early course of the illness. The patient was initially suspected of having a primary psychiatric disorder, but anti-NMDAR antibodies were found in the cerebrospinal fluid, and HSV-1 positivity was confirmed by real-time polymerase chain reaction.
Cerebrospinal fluid testing
The report lays out the tests that changed the diagnosis: cerebrospinal fluid analysis found anti-NMDAR antibodies, and real-time PCR identified HSV-1. Those results moved the case from a psychiatric presentation to overlapping viral and autoimmune encephalitis, which required treatment on both fronts.
She received high-dose corticosteroids, IVIG, plasmapheresis, rituximab, acyclovir, and antiviral therapy. The authors said patients with acute neuropsychiatric symptoms require early recognition, repeated CSF testing, and multidisciplinary management.
ICU course
The hospitalization became prolonged after she was admitted to the ICU with respiratory failure, septic shock, and acute kidney injury. The case report was written by Pratik Rathi, Fahad Idrees Shaikh, Tanuja Manohar, Arvind Agrawal, and Nishka Tiwari, and it adds another documented example of how HSV-1 can sit at the start of an autoimmune encephalitis picture in a young woman.
