Czarnowska et al.
A fatal case of tick-borne encephalitis in an immunocompromised patient: case report from Northeastern Poland and review of literature
Ticks Tick Borne Dis. 2024;15(1):102273. doi:10.1016/j.ttbdis.2023.102273
A TBE case has been described in a 36-year-old female patient with a history of double corneal transplantation and a post-transplant immunosuppressive therapy. This woman suffered from headache, nausea, dizziness, vomiting and fever over a week. The patient lived in a TBE endemic region in northeastern Poland and was not vaccinated against TBE. The neurological examination upon hospital admission revealed among other things impaired consciousness and mutism. Cerebrospinal fluid was negative for antibodies against TBE virus. After transfer into the intensive care unit, pharmacological coma was induced.
Although the first sample of CSF was TBE antibody negative, the second and third samples were IgM and IgG TBE ELISA positive, and this was confirmed by neutralizing antibodies. The outcome of TBE was fatal.
This case shows that TBE virus infection can be a potential threat for organ transplant patients. Possibly due to the immunosuppression, the severity of disease was overwhelming. Delayed production of TBE antibodies can complicate the diagnosis in immunosuppressed patients. A limitation of the study was that no detection of virus RNA in the serum of CSF was carried out, which has been described as beneficial in patients with humoral immunodeficiencies (see e.g., Snapshot week 6/2024).
Recently, another case of delayed TBE antibody production in an immunocompromised patient (with fatal outcome) has been reported by Litvová et al., Zdravotnicke listy. 2023;4:13-18.