Emergency Department Course: Manuel was driven to the emergency room by his parents. On arrival, he appeared very confused, though not agitated. With his encephalopathic picture, we were most worried about psychotropic drug abuse or infection. A normal urine drug screen and a CBC with an elevated WBC count were suspicious for infection. Because encephalitis and meningitis were the main concerns, we performed a lumbar puncture. The opening pressure was consistent with elevated intracranial pressure. The CSF showed an elevated WBC count. The culture is pending. Shortly after his lumbar puncture, Manuel had a tonic-clonic seizure. We treated him with an anticonvulsant and the seizure stopped. The electroencephalogram showed paroxysmal lateral epileptiform discharges (PLEDs), which are characteristic of herpes encephalitis. The pediatric team was called, and they admitted him to the PICU.