Neurological Disorders

Harlequin Syndrome Secondary to Herpes Simplex Encephalitis

Abstract

Abhishek Dixit, Abhishek Pathak, Anand Kumar, Rameshwar Nath Chaurasi, Vijaya Nath Mishra, Deepika Joshi, Varun Kumar Singh* and Pratishtha Sengar

Background: Harlequin syndrome is a rare dysautonomia syndrome characterized by increased sweating on one side and anhidrosis on the contralateral side of the body.

Case report: A 24 years old male presented with fever, multiple episodes of focal seizures with bilateral tonic clonic movements and altered sensorium. On evaluation, he was diagnosed as a case of Herpes Simplex Encephalitis based on classical radiological and positive cerebrospinal fluid real time polymerase chain reaction test for herpes simplex virus 1. He received full course of intravenous acyclovir during hospital stay and discharged on two antiepileptics. During follow up, he developed increased sweating on one half of face and anhidrosis over another half suggestive of Harlequin syndrome. However, these symptoms subsided by its own without any active intervention during further follow up.

Conclusion: To the best of our knowledge, this is the first report of Harlequin syndrome secondary to herpes simplex encephalitis.