Teaching NeuroImage: Human Encephalitis Caused by Pseudorabies Virus Infection

A 51-year-old woman presented with fever and loss of consciousness for 4 days. Images showed symmetrical lesions in bilateral cortex, limbic system, and basal ganglia (Figure). CSF analysis suggested viral infection. Next-generation sequencing identified 349 unique sequence reads for pseudorabies virus (PRV). She was diagnosed with PRV encephalitis. Epidemiologic survey revealed she was a pork dealer. PRV, also called Suid herpesvirus-1, primarily infects swine. It is reported that PRV can cause human infection through infected swine or pork.1,2 This case suggests unexplained severe encephalitis with similar MRI, and a history of relevant exposure should consider the possibility of PRV infection.