Articles

<b>Background: </b>In Systemic lupus erythematosus (SLE), a chronic multisystem autoimmune disease, central nervous system infections are uncommon, affecting about 1% of cases. However, diagnosis is often challenging due to overlapping autoimmune and infectious features, nonspecific neurological symptoms, and limited diagnostic specificity, which may delay appropriate treatment and worsen outcomes. <b>Case Report:</b> An 80-year-old male with a five-year history of systemic lupus erythematosus (SLE) presented with a two-day history of generalized weakness that subsequently progressed to recurrent focal seizures and later to generalized seizures accompanied by a profound decline in consciousness. Despite adequate administration of antiepileptic and sedative therapy, persistent seizure activity was observed. Meningitis Panel evaluation confirmed herpes simplex virus type 1 (HSV-1) encephalitis, complicated by severe systemic inflammation, anemia, thrombocytopenia, renal dysfunction, and respiratory acidosis findings indicative of multi-organ failure. Magnetic resonance imaging of the brain revealed bilateral asymmetric hyperintense lesions involving the insular regions, medial temporal lobes, and frontal cortices, consistent with viral encephalitis. The patient underwent comprehensive intensive care management, including intravenous antiviral, antimicrobial, corticosteroid, and supportive therapies. However, his clinical condition progressively deteriorated, culminating in death on the fourth day of hospitalization. <b>Discussion: </b>This case illustrates the diagnostic and therapeutic complexity of herpes simplex virus type 1 (HSV-1) encephalitis in a patient with systemic lupus erythematosus (SLE), a rare but fatal complication. In immunocompromised individuals, atypical clinical and cerebrospinal fluid findings may obscure diagnosis and delay treatment. Immunosuppressive therapy and underlying immune dysregulation further increase vulnerability to opportunistic infections and multi-organ failure. Early recognition of viral encephalitis in SLE patients with acute neurological symptoms is therefore crucial to optimize outcomes. <b>Conclusion:</b> Encephalitis in SLE is a rare but serious complication with overlapping autoimmune and infectious features. Early recognition and timely antiviral immunosuppressive therapy are essential to improve outcomes.