A 22-year-old woman presents with fever, headache, and confusion. She has not been herself for the past 2 days, including not going to work and forgetting events. On examination, she is moving all her limbs, but not oriented to place or time. The remaining examination is normal. A CT scan shows bilateral, small, low-density temporal lobe lesions. Cerebrospinal fluid (CSF) shows mononuclear cell pleocytosis, increased protein, and normal glucose. The electroencephalogram (EEG) shows bilateral periodic discharges from the temporal leads and slow-wave complexes at regular intervals of 2-3/sec. Which of the following is the most appropriate treatment for her condition?
High-Yield Explanation
This patient has herpes simplex virus encephalitis. Acyclovir selectively inhibits viral deoxyribonucleic acid (DNA) polymerase. Acyclovir is currently the treatment of choice because of better efficacy and less toxicity than previous drugs. Because it is so nontoxic, therapy can be started even if the diagnosis is only presumptive.