Modern Pediatrics. Ukraine. (2026).4(156): 148-152. doi: 10.15574/SP.2026.4(156).148152
Shcherbatiuk N. Yu., Mudryk U. M., Volianska L. A., Kosovska T. M., Burbela E. I., Peresstiuk V. O., Boyarchuk O. R.
I. Horbachevsky Ternopil National Medical University, Ukraine

For citation: Shcherbatiuk NYu, Mudryk UM, Volianska LA, Kosovska TM, Burbela EI, Peresstiuk VO, Boyarchuk OR. (2026). Clinical case of herpetic encephalitis in a teenager with a history of tick bite on the background of comorbidity. Modern Pediatrics. Ukraine. 4(156): 148-152. doi: 10.15574/SP.2026.4(156).148152.
Article received: Feb 09, 2026. Accepted for publication: May 12, 2026.

Herpetic encephalitis (HE) accounts for 10-42% from the total number of viral encephalitis in the world with an incidence rate of up to 0.8 per 100 thousand populations. Mortality in HE without antiviral treatment is 60-70%, with the use of acyclovir it decreases to 15-20%. The infection occurs in all age groups, with one third of all cases occurring in children and teenagers.
Aim – to raise the medical community's awareness of etiotropic treatment strategies by differentiating the etiological factor based on a clinical case.
A clinical case of НE in a 17-year-old girl is presented, with a history of a tick bite against a background of chronic gastroduodenal and hepatobiliary pathology and emotional-volitional instability syndrome, where complaints of a dyspeptic and astheno-vegetative nature predominated at the onset of the disease. Immunological studies revealed IgG antibodies to Epstein-Barr virus, cytomegalovirus, IgM to herpes simplex virus types 1 and 2, Borrelia burgdorferi, immunoblotting for borreliosis – the result was questionable. Blood PCR for borreliosis – the result was negative. The lack of sufficient paraclinical criteria denied the diagnosis of borreliosis encephalitis, making it possible to focus on antiviral etiotropic therapy of herpetic infection.
Conclusions. It is not always easy to identify an acute inflammatory process in the central nervous system as the cause of complaints of vomiting, headaches, and emotional and psychological discomfort in an older child. Comparison of the data of the anamnesis of life and disease with immunological examination played an important role in diagnosing the etiotropic pathogen of encephalitis. Herpes viruses of the first and second types cause massive brain lesions. Increasing the awareness of the medical community regarding the clinical features of the course of encephalitis in adolescents against the background of the risk of infection with other pathogens and the presence of somatic chronic pathology with emotional and psychological problems will contribute to the timely appointment of etiotropic treatment and prevention of the development of complications.
The study was conducted according to the principles of the Helsinki Declaration. Informed consent was obtained from the patient for the study.
The authors declare no conflict of interest.
Keywords: encephalitis, herpes virus, teenagers.

REFERENCES

1. Bogovic P, Lotric-Furlan S, Strle F. (2010). What tick-borne encephalitis may look like: clinical signs and symptoms. Travel Med Infect Dis. 8: 246-250. https://doi.org/10.1016/j.tmaid.2010.05.011; PMid:20970727

2. Boyarchuk O, Volianska L. (2023) Autoimmunity and long COVID in children. Reumatologia. 61(6):492-501. https://doi.org/10.5114/reum/176464; PMid:38322108 PMCid:PMC10839920

3. Davies N, Roshan KB. (2025). Herpes simplex virus encephalitis: Overview. URL: https://www.encephalitis.info/types-of-encephalitis/infectious-encephalitis/herpes-simplex-virus-encephalitis/gad_source=1&gclid=Cj0KCQjwtJ6_BhDWARIsAGa.

4. Chan YH, Lundberg V, Le Pen J, Yuan J, Lee D, Pinci F, et al. (2024). SARS-CoV-2 brainstem encephalitis in human inherited DBR1 deficiency. J Exp Med. 221(9):e20231725. https://doi.org/10.1084/jem.20231725; PMid:39023559

5. Ecker M, Allison SL, Meixner T, Heinz FX. (1999). Sequence analysis and genetic classification of tick-borne encephalitis viruses from Europe and Asia. J Gen Virol. 80(1): 179-185. https://doi.org/10.1099/0022-1317-80-1-179; PMid:9934700

6. Granerod J, Ambrose HE, Davies NW, Clewley JP, Walsh AL, Morgan D et al. (2010). Causes of encephalitis and differences in their clinical presentations in England: a multicentre, po-pulation-based prospective study. Lancet Infect. Dis. 10(12): 835-844. https://doi.org/10.1016/S1473-3099(10)70222-X; PMid:20952256

7. Gulizia C, Smilari P, Filippo Greco F, Fontana A, Ceccarelli M, Venanzi Rullo E. (2021). Atypical Presentation of Herpes Simplex Virus 1 Encephalitis in Pediatric Age. OAMJMS. 9: 204-208. https://doi.org/10.3889/oamjms.2021.6244

8. Kaeley N, Bansal S, Bhatia R, A hmad S. (2016). Herpes Simplex Encephalitis: An Uncommon Presentation. J. Clin. Diagn Res. 10 (5): 25-26. https://doi.org/10.7860/JCDR/2016/19040.7801; PMid:27437286 PMCid:PMC4948462

9. Krel R. (2024). Cytomegalovirus Encephalitis in HIV. Overview. URL: https://emedicine.medscape.com/article/1167229-overview#showall.

10. Lakhan SE. (2021). Herpes Simplex Encephalitis: Overview. URL: //https://emedicine.medscape.com/article/1165183.

11. Mailles A. (2009). Infectious encephalitis in France in 2007: a national prospective study. Clinical Infectious Diseases. 49: 1838-1847. https://doi.org/10.1086/648419; PMid:19929384

12. Seo HE, Hwang SK, Choe BH et al. (2010). Clinical spectrum and prognostic factors of acute necrotizing encephalopathy in children. J. Korean. Med. Sci. 25: 449-453. https://doi.org/10.3346/jkms.2010.25.3.449; PMid:20191046 PMCid:PMC2826728

13. Volokha AP. (2013).Viral encephalitis in children (lecture). Modern pediatrics 8: 139-144.

14. Volianska LA, Boyarchuk OR, Mudryk UM, Burbela EI, Peresstiuk VO, Kosovska TM et al. (2025) Modern infectious and immune-related causes of acute encephalitis in children. Modern pediatrics . Ukraine. 8(152): 70-78. https://doi.org/10.15574/SP.2025.8(152).7078

15. Working Group of the NIH Office of AIDS Research Advisory Council (OARAC). (2024). Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents With HIV. URL: https://clinicalinfo.hiv.gov/en/guidelines/adult-and-adolescent-opportunistic-infection.