Severe herpes simplex virus encephalitis complicated by atypical Takotsubo cardiomyopathy with left ventricular systolic dysfunction

A previously healthy woman in her 30s presented with high-grade fever, photophobia and fluctuating consciousness, and was diagnosed with herpes simplex virus type 1\ encephalitis. Her condition deteriorated, requiring intensive care support for type 1 respiratory failure. During her intensive care unit stay, she was found to have significant left ventricular systolic dysfunction with basal-mid akinesia and apical sparing on echocardiography. Cardiac MRI demonstrated features consistent with stress-induced (Takotsubo) cardiomyopathy. She made a complete neurological and cardiac recovery with supportive care, antiviral therapy and temporary heart-failure therapy. This case highlights the importance of considering cardiac involvement in severe encephalitis and the multidisciplinary management required for rare neuro-cardiac interactions.