Aleissa M, Busbait SA, Bhullar R, Singh JP, Bhullar JS, Mittal VK. Herpes simplex encephalitis associated with infliximab therapy for ulcerative colitis: A case report. World J Clin Cases 2026; 14(11): 119107 [DOI: 10.12998/wjcc.v14.i11.119107]
Corresponding Author of This Article
Jasneet S Bhullar, MD, FACS, FASCRS, Department of Surgery, Henry Ford Providence Hospital, Michigan State University College of Human Medicine, 16001 W Nine Mile Rd, Southfield, MI 48075, United States. drjsbhullar@gmail.com
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Gastroenterology & Hepatology
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Case Report
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Apr 16, 2026 (publication date) through Apr 15, 2026
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World Journal of Clinical Cases
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2307-8960
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Aleissa M, Busbait SA, Bhullar R, Singh JP, Bhullar JS, Mittal VK. Herpes simplex encephalitis associated with infliximab therapy for ulcerative colitis: A case report. World J Clin Cases 2026; 14(11): 119107 [DOI: 10.12998/wjcc.v14.i11.119107]
World J Clin Cases. Apr 16, 2026; 14(11): 119107 Published online Apr 16, 2026. doi: 10.12998/wjcc.v14.i11.119107
Herpes simplex encephalitis associated with infliximab therapy for ulcerative colitis: A case report
Maryam Aleissa, Saleh A Busbait, Ryba Bhullar, Jai P Singh, Jasneet S Bhullar, Vijay K Mittal
Maryam Aleissa, Saleh A Busbait, Ryba Bhullar, Jai P Singh, Jasneet S Bhullar, Vijay K Mittal, Department of Surgery, Henry Ford Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI 48075, United States
Maryam Aleissa, Department of Surgery, Princess Nourah Bint Abdulrahman University, Riyadh 84428, Saudi Arabia
Saleh A Busbait, Department of Surgery, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
Author contributions: Aleissa MA, Busbait SB, Bhullar RB, Mittal VM, Singh JP, and Bhullar JB designed the concept and outline and contributed to the writing and review of the literature; Aleissa MA, Bhullar JB, and Busbait SB were responsible for the oversight and coordination; All authors contributed to the editing of the manuscript. Bhullar JB is the corresponding author of this manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Jasneet S Bhullar, MD, FACS, FASCRS, Department of Surgery, Henry Ford Providence Hospital, Michigan State University College of Human Medicine, 16001 W Nine Mile Rd, Southfield, MI 48075, United States. drjsbhullar@gmail.com
Received: January 23, 2026 Revised: February 21, 2026 Accepted: March 9, 2026 Published online: April 16, 2026 Processing time: 77 Days and 2.9 Hours
Abstract
BACKGROUND
Infliximab, an inhibitor of tumor necrosis factor alpha, is effective for inducing clinical remission in moderate to severe ulcerative colitis (UC). While generally safe, infliximab carries a risk of viral and bacterial reactivation, such as tuberculosis and hepatitis B virus. Reactivation of herpes simplex virus (HSV) leading to encephalitis remains incompletely characterized.
CASE SUMMARY
A 54-year-old female with UC exacerbation was transitioned to infliximab therapy after a partial response to corticosteroids. Three days post-infusion, she developed acute neurological symptoms, including confusion, aphasia, and respiratory distress, necessitating intubation. Initial computed tomography imaging was unremarkable. Magnetic resonance imaging demonstrated bilateral medial temporal lobe edema and limbic involvement. Cerebrospinal fluid analysis revealed mildly elevated white blood cells and glucose. PCR testing confirmed HSV-1 encephalitis. The patient was treated with intravenous acyclovir, resulting in gradual clinical improvement, although persistent neurological deficits remained.
CONCLUSION
HSV encephalitis, although rare, is a potential complication of infliximab. Early suspicion, diagnosis, and initiation of empirical acyclovir are essential to improve outcomes.
Core Tip: Herpes simplex encephalitis is a rare but potentially fatal complication of tumor necrosis factor alpha (TNF-α) inhibitor therapy. This case presents a rare instance of herpes simplex virus type 1 encephalitis, which developed only a few days after starting infliximab treatment for ulcerative colitis. Published literature provides evidence that TNF-α functions as a vital factor that protects against viral infections in the nervous system. Inhibition of TNF-α action allows viruses to reactivate and enter the brain. The treatment of herpes simplex encephalitis requires early recognition and an immediate cerebrospinal fluid PCR sample and initiation of antiviral medication to achieve better neurological results.
