A rare presentation of herpes simplex virus type 2 encephalitis following primary genital herpes in an immunocompetent female: An unusual case.

Herpes simplex virus type 2 (HSV-2) is a common cause of genital herpes but rarely causes encephalitis in immunocompetent adults. We report a case of a 20-year-old immunocompetent woman who developed HSV-2 encephalitis following a primary genital infection. She initially presented with multiple painful genital ulcers and herpetic whitlow, confirmed as primary HSV infection and treated with oral acyclovir. One month later, she developed seizures, confusion, and hallucinations. Magnetic resonance imaging revealed T2/FLAIR hyperintensities in the left cerebral cortex and thalamus, and cerebrospinal fluid polymerase chain reaction detected HSV-2 DNA. Despite intravenous acyclovir therapy, she relapsed after 45 days and succumbed. This case highlights that primary genital HSV-2 infection can have severe and fatal neurological complications even in the absence of immunosuppression. Early recognition, timely antiviral therapy, and vigilance for relapse or autoimmune encephalitis are essential.