Psychosis in a 15-Year-Old Female withHerpes Simplex Encephalitis in a Background ofMannose-Binding Lecithin Deficiency

Historically, psychotic disorder has been associated with viral infection. Herpes simplex infections and Epstein-Barr virus (EBV)among other viral infections have been implicated in psychotic disorder. Of note in this case report is psychotic disorder thatoccurred following reactivation of herpes simplex infection in a background of mannose-binding lecithin (MBL) deficiency, child-hood EBV infection, and severe psychosocial stress. Herpes simplex encephalitis (HSE) remains a significant cause of morbidity andmortality despite advancement in its treatment with intravenous acyclovir. Many studies have reported psychiatric and neurologicalmanifestation of herpes simplex infection following primary or reactivated infection, while others suggest milder clinical course ofherpes simplex encephalitis in a background of immunosuppression. Another contributory factor to psychotic disorder in this caseis childhood EBV exposure which has been reported to increase the risk of psychosis in adolescence and adulthood. This case reportdescribes a 15-year-old female with MBL deficiency who presented with psychosis caused by reactivated herpes simplex infectionand had good clinical recovery. Based on childhood Epstein-Barr virus exposure and psychosis in adolescence (current case), sheis at increased risk of psychotic disorder in adulthood, which underscores the importance of long-term monitoring.