When the brain slows the heart—herpes encephalitis and sinus arrest: a case report

Abstract Background Herpes simplex virus (HSV) encephalitis is a known cause of cognitive deterioration, neurological disturbances, and seizures though are rarely associated with sinus node dysfunction. Case summary We present a 54-year-old man admitted to the hospital with a 10-day history of fever...

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Bibliographic Details
Published inEuropean heart journal : case reports Vol. 5; no. 8
Main Authors Braiman, Dana, Konstantino, Yuval, Westreich, Roi
Format Journal Article
LanguageEnglish
Published Oxford University Press 01.08.2021
Subjects
Acyclovir
Case Report
Electrocardiogram
Electrocardiography
Encephalitis
Fainting
Herpes
Herpesvirus diseases
Case report
Sinus arrest
Syncope
Herpes simplex encephalitis
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Summary:Abstract Background Herpes simplex virus (HSV) encephalitis is a known cause of cognitive deterioration, neurological disturbances, and seizures though are rarely associated with sinus node dysfunction. Case summary We present a 54-year-old man admitted to the hospital with a 10-day history of fever, confusion, and fatigue, 1 week following a transient loss of consciousness. An initial workup suggested HSV encephalitis and the patient was started on intravenous Acyclovir. Due to his episode of syncope, a 24 h Holter electrocardiogram monitoring was performed. The Holter documented multiple episodes of sinus arrest, with a second episode of syncope noticed by the hospital staff concurrent with the last documented sinus arrest. Following antiviral treatment and resolution of the encephalitis we noticed complete resolution of sinus node dysfunction. We subsequently avoided permanent pacemaker implantation. Discussion Our case of proven HSV encephalitis complicated by sinus node arrest and syncope with complete resolution following antiviral treatment suggests no indication for permanent pacemaker implantation. This approach is consistent with data from previously reported cases.
ISSN:2514-2119
2514-2119
DOI:10.1093/ehjcr/ytab254