Clinical Case Database / Category: Patient Management

A febrile and confused patient

Publication details

Alastair McGregor, Michael Brown
Foundation Years Journal, volume 3, issue 1, p.18 (123Doc Education, London, February 2009)


The confused and febrile patient is a staple of acute medical takes. The differential is often wide, ranging from the common but relatively trivial to the rare but life-threatening. Below we present a typical case, discuss the causes not to miss, how to recognise these patients and how to ensure that they are managed optimally.

Access the Clinical Cases Database

A subscription is required to read the full article. Please subscribe using one of the options below.

Foundation Years Clinical Cases Database£29.006 months
Add to cart
Foundation Years Clinical Cases Database£39.0012 months
Add to cart


Alastair McGregor

Infectious Diseases and Microbiology
Royal Free Hospital

Michael Brown

Hospital for Tropical Diseases
University College London Hospitals NHS Trust


1. Gordon B, Selnes OA, Hart J, Hanley DF, et al. Long-term cognitive sequelae of aciclovir treated herpes simplex encephalitis. Arch Neurol, 1990, 47:646.
2. Benson PC, Swadron SP. Empiric aciclovir is infrequently initiated in the emergency department to patients ultimately diagnosed with encephalitis. Ann Emerg Med, 2006, 47:100.
3. Misra UK, Kalita J. Neurophysiological studies in herpes simplex encephalitis. Electromyogr Clin Neurophysiol, 1998, 38:177.
4. Levitz RE. Herpes simplex encephalitis: A review. Heart Lung, 1998, 27:209.
5. Domingues RB, Fink MC, Tsanaclis AM, et al. Diagnosis of herpes simplex encephalitis by magnetic resonance imaging and polymerase chain reaction assay of cerebrospinal fluid. J Neurol Sci, 1998, 157:148.
6. Kupila L, Vuorinen t, Vainionpaa R, et al. Etiology of aseptic meningitis and encephalitis in an adult population. Neurology, 2006, 66:75.
7. Lakeman FD, Whitley RJ. Diagnosis of herpes simplex encephalitis: Application of polymerase chain reaction to cerebrospinal fluid from brain-biopsied patients and correlation with disease. National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. J Infect Dis, 1995, 171:857.
8. Valencia I, Miles DK, Melvin J, et al. Relapse of herpes encephalitis after aciclovir therapy: report of two new cases and review of the literature. Neuropediatrics, 2004, 35:371.
9. Tyler KL. Herpes simplex virus infections of the central nervous system: encephalitis and meningitis, including Mollaret's. Herpes, 2004, suppl 11, 2:57A.
10. Hjalmarsson A, Blomqvist P, Skoldenberg B. Herpes simplex encephalitis in Sweden, 1990–2001: incidence, morbidity, and mortality. Clin Infect Dis, 2007, 45:875.


Conflict Of Interest

The Journal requires that authors disclose any potential conflict of interest that they may have. This is clearly stated in the Journal’s published “Guidelines for Authors”. The Journal follows the Guidelines against Conflict of Interest published in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals (

Financial Statement

The authors of this article have not been paid. The Journal is financed by subscriptions and advertising. The Journal does not receive money from any other sources. The decision to accept or refuse this article for publication was free from financial considerations and was solely the responsibility of the Editorial Panel and Editor-in-Chief.

Patient Consent statement

All pictures and investigations shown in this article are shown with the patients’ consent. We require Authors to maintain patients’ anonymity and to obtain consent to report investigations and pictures involving human subjects when anonymity may be compromised. The Journal follows the Guidelines of the Uniform Requirements for Manuscripts ( The Journal requires in its Guidelines for Authors a statement from Authors that “the subject gave informed consent”.

Animal & Human Rights

When reporting experiments on human subjects, the Journal requires authors to indicate whether the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the HelsinkiDeclaration of 1975, as revised in 2008.

About the Clinical Cases Database

T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

The database is fully searchable, or can be browsed by medical specialty. Abstracts can be read free of charge, however a subscription is required in order to read the complete cases.