Clinical Challenges in a 49-Year-Old Patient with Severe Tick-Borne Myeloradiculitis Despite Complete Active Vaccination

Abstract

Vaccination is an effective means to prevent infectious diseases including tick-borne encephalitis (TBE), an emerging Flavivirus infection. There is, however, only limited knowledge about risk of vaccination failure, the disease course and the challenges for work-up and care. Of note, there is evidence that patients with breakthrough disease experience a more severe disease course. We report the case of a previously healthy 49-year-old woman who developed severe myeloradiculitis caused by the TBE virus despite receiving a complete cycle of primary immunization and booster vaccinations within the recommended timeframe. The disease course was characterized by progressive tetraparesis, pain and bladder dysfunction and necessitated intensive care unit admission (ICU) and the escalation of pain management. This case raises awareness for the recognition of breakthrough disease in younger patients and reinforces the need to develop measures to identify patients with insufficient protection.

Neurologic complications of coronavirus and other respiratory viral infections

“…The infection may preferentially involve spinal cord gray matter, white matter, or both in viral myelitis. The area of spinal cord involvement generally extends to at least several vertebral segments ( Nardone et al, 2017 ; Feige et al, 2020 ). Myelitis with bilateral corticospinal tract involvement at high cervical levels may lead to “autonomous breathing,” with loss of ability to initiate voluntary respiratory movements ( Nogues and Benarroch, 2008 ).…”

Case Report: Ascending Myelo-Encephalitis after a Penetrating Injury to the Foot: An Atypical Case of Neuromelioidosis

“…When projection fibers, and long and short association fibers are involved, a "tractopathic" lesion can be discerned on MRI and should arouse the suspicion of an infective tractopathy with an organism that migrates along axonal tracts such as herpes simplex virus, West Nile virus, poliomyelitis, tick-borne encephalitis, Listeria, or B. pseudomallei. 9,10 Antibiotic therapy for NM includes parenteral ceftazidime or carbapenem plus co-trimoxazole for 4 weeks, followed by oral therapy with co-trimoxazole for a minimum of 3 months. 7,11 Recurrent melioidosis occurs with noncompliance or incomplete treatment but can also occur after apparent cure 2 ; 75% of recurrences are due to original strain and occur within a year of the initial episode, whereas 25% of recurrences are due to reinfection and occur later than 1 year 12.…”