Neill et al.
Rhombencephalitis and myeloradiculitis caused by European subtype of tick-borne encephalitis virus
Emerg. Infect. Dis., in press, doi.org/10.3201/eid2512.191017
A severe form of TBE has been diagnosed in a previously healthy 38-year-old man from the United Kingdom who has traveled to Lithuania and visited woodlands in the Kaunas region. Seven days after arriving in Lithuania, the patient developed influenza-like symptoms. Ten days later, he reported neck stiffness, photophobia, tongue deviation to the left. Then, progressive bilateral lower limb weakness in his hip, urinary retention, and constipation developed. Pleocytosis was identified in the cerebrospinal fluid. Two days after neurologic signs began, the patient became breathless and drowsy. Neurologic examination revealed dysarthria, interrupted saccades, and difficulty with alternating lateral tongue movements. Because forced vital capacity was only 800 ml due to respiratory muscle weakness, the patient was intubated and transferred to a neurology hospital. His neurologic syndrome was consistent with rhombencephalitis and myeloradiculitis.
Serum and urine tested positive for the TBE virus RNA, and serum and CSF were positive for TBE IgG. The gene coding for glycoprotein E could be sequenced and phylogenetic analysis revealed the isolate was of the European subtype. These data show that extreme severe forms of TBE can also be caused by the European subtype. This case underscores the importance of vaccination among groups of susceptible people (e.g. travelers to TBE endemic regions) and improved awareness of TBE.