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Acute viral encephalitis complicating a first manic episode.

The diagnosis of viral encephalitis in a patient with acute mania was difficult because of symptom overlap and inconclusive laboratory evaluations. Final differentiation was made clinically. Despite the generally assumed usefulness of diagnostic tests for encephalitis, only the electroencephalogram showed consistent sensitivity in this patient and in similar previously reported cases. Diagnosis was further complicated by the potential side effects of neuroleptic medications, which may mimic infection through extrapyramidal symptoms, fever, or altered blood counts. In addition, legitimate physical complaints were discounted as a result of the patient's psychiatric status.