Concurrent brain infection of herpes simplex virus and tuberculous meningitis complicated by tuberculous abscess: a case report.

Publication date: Jul 22, 2025

Herpes simplex encephalitis is the most common form of encephalitis, while tuberculous meningitis is a rare condition accounting for less than 1% of all tuberculosis cases. Since the symptoms are similar in both diseases, differentiating between them is a clinical challenge, even after performing cerebrospinal fluid analysis, as the final diagnosis remains based on the specific investigations that were unusually positive for both diseases in our patient, which have not been reported previously, making this case the first in medical literature on this subject. A 45-year-old Syrian male patient presented with fever, headache, and generalized seizures with decreased cognitive function. He was referred to the emergency department, where radiological investigations and other tests revealed concurrent infection with herpes simplex encephalitis and tuberculous meningitis with tuberculous brain abscesses confirming involvement of the brain parenchyma by both infections. The patient was treated with intravenous acyclovir, antituberculosis regimen, and anticonvulsants, resulting in notable clinical improvement. However, he experienced a tonic-clonic seizure, complicated by aspiration pneumonia, and later developed acute respiratory failure and succumbed to his condition on the 21st day of hospitalization. Although the presentations of herpes simplex encephalitis and tuberculous meningitis are similar, clinicians should not exclude one diagnosis when the other is confirmed, as both conditions can coexist in the same patient, as our case report demonstrates.

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