['Tick-borne' encephalitis in an immunocompromised patient]

Abstract

Background: 'Tick-borne' encephalitis virus (TBEV) is a flavivirus that is transmitted by ticks. TBEV is endemic in East Asia, Russia and a number of other European countries. In the Netherlands it is seen only in travellers who have been to these regions. The clinical picture is variable: from a mild form of meningitis to lethal meningoencephalomyelitis. There are no therapeutic options available, only symptomatic treatments.

Case description: A 48-year-old woman with a history of systemic lupus erythematosus (SLE) for which she used immunosuppressives, developed meningoradiculoencephalitis following a holiday in Germany. She was initially treated for cerebral SLE vasculitis, but it later became apparent that it was a tick-borne encephalitis. The patient died of abscessing pneumonia following protracted mechanical ventilation.

Conclusion: Tick-borne encephalitis may have serious consequences. Important is to think of this infection in patients who travelled to endemic areas. Vaccination should be recommended to travellers visiting endemic regions, especially if they are immunocompromised.