Clinical Reasoning: A 49-Year-Old Man With Meningoencephalitis and Persistent Altered Mental Status

Persistent altered mental status in acute meningoencephalitis poses a significant diagnostic and therapeutic challenge. We report a 49-year-old man who presented with fever, headache, and status epilepticus. Despite initial positive bacterial cultures and appropriate antimicrobial therapy, his mentation remained poor. MRI brain suggested a likely diagnosis, which was subsequently confirmed on autopsy. This case highlights the importance of a systematic approach in evaluating persistent altered mental status in meningoencephalitis, incorporating a detailed clinical history, comprehensive systemic assessment, and timely, targeted investigations to explore a broad range of potential mechanisms.