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A 22-year-old man presents to the emergency department in late summer with a 2-day history of headache, fever, and photophobia. He reports mild neck stiffness but no confusion or focal neurological deficits. He is otherwise healthy and takes no medications. He attends college in Wisconsin and lives in a dormitory. On examination, temperature is 38.2 °C (100.8 °F), heart rate is 88/min, and blood pressure is 118/72 mm Hg. He is alert and oriented. No rash is present. Cerebrospinal fluid analysis reveals: • Leukocyte count: 180/µL (predominantly lymphocytes) • Glucose: 65 mg/dL (normal) • Protein: 48 mg/dL (mildly elevated) • Gram stain: Negative • Bacterial cultures: Pending Which of the following is the most likely causative virus? A) Herpes simplex virus type 1 B) Varicella-zoster virus C) Epstein-Barr virus D) Enterovirus E) Human herpesvirus 6
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