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A 19-year-old woman with no significant past medical history presented to the hospital after a 1-week illness. Her symptoms began with 2 days of vomiting, diarrhoea and decreased sensation in the fingertips. She subsequently developed emotional lability and auditory hallucinations characterised by a persistent background humming. On the fifth day of her illness, she developed dysarthria and expressive aphasia. Initial examination approximately 1 week from symptom onset was significant for expressive and receptive aphasia, inattention and disorganisation, and fluctuating mental status consistent with delirium, with no obvious motor deficits. Brain MRI revealed a left medial temporal T2 hyperintensity without enhancement on FLAIR (figure 1A). Cerebrospinal fluid (CSF) revealed 129 nucleated cells with a lymphocytic predominance and no red blood cells. Extensive …
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