An African American woman initially presents with headache, fever, and "flu-like symptoms." She takes a few days off work, but then starts to develop odd psychiatric symptoms. She has new anxiety, agitation, and bizarre behavior. Her husband thinks she's hallucinating and has delusions. She has gaps in her memory, cannot sleep, and develops strange orofacial dyskinesias. Over the ensuing few days, she has a seizure, becomes mute, and develops stupor with catatonic features. Vital signs show hyperthermia and inconsistent blood pressures and heart rates; over the hospitalization, she has hypertension, hypotension, tachycardia, and bradycardia. Neuro exam shows dystonia and rigidity. CSF shows lymphocytic pleocytosis. EEG shows slow, disorganized activity that does not correlate with abnormal movements. Brain MRI is normal. CT of the abdomen and pelvis is shown below:
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