Tick-borne encephalitis related uveitis: a case report

Abstract

Background Tick-borne encephalitis (TBE) is an infectious disease of the central nervous system caused by the TBE virus (TBEV), which is usually transmitted by a tick-bite, with increasing incidence in northeastern Europe and eastern Asia during the past decade. Ocular involvement has not been described in the literature to date. Case presentation A 58-year-old patient presented to the emergency department with occipital headaches and poor balance for 5 days. He reported a tick-bite 6 weeks before without erythema migrans followed by a flu-like syndrome. Serological testing was negative for Borreliosis and TBEV. At presentation, he was febrile with neck stiffness and signs of ataxia. Three days later, he presented unilateral visual loss in his right eye. Examination revealed non granulomatous anterior uveitis, vitreous inflammation, and retinal haemorrhages at the posterior pole without macular oedema or papillitis. Polymerase chain reaction (PCR) of the cerebrospinal fluid returned negative for all Herpes family viruses. No clinical evidence of other infection nor malignancy was identified. A seroconversion of the TBEV- immunoglobulin titres was observed 2 weeks later while the serum antibodies for Borrelia were still not detected. Magnetic resonance imaging was unremarkable. We concluded to the diagnosis of TBE-related uveitis. Under supportive treatment, there was complete resolution of the neurological symptoms and the intraocular inflammation without sequelae within the following weeks. Conclusions We describe a new association of TBEV with uveitis. In view of the growing number of TBE cases and the potential severity of the disease we aim at heightening awareness to achieve prompt recognition, prevention, and treatment.

A comprehensive neurological perspective on tick-borne flaviviruses, with emphasis on Powassan virus

“… 15 In addition to neurological complications, eye involvement, though rare, can present with symptoms such as non-granulomatous anterior uveitis, vitreous inflammation, and retinal haemorrhages, along with bilateral multifocal chorioretinitis. 30 , 88 …”

Revenge of the Tick: Tick-Borne Diseases and the Eye in the Age of Climate Change and Globalisation

“…6 weeks after a tick bite, where he experienced a flu-like illness 10 days later but no erythema migrans [197].…”

“…He also received empiric intravenous acyclovir 10 mg/kg three times a day to cover for possible herpes meningoencephalitis with retinal involvement, although PCR of the cerebrospinal fluid returned negative for all Herpes family viruses and the acyclovir was subsequently discontinued. Supportive care was pursued, and the neurological symptoms resolved completely in three weeks along with complete resolution of intraocular inflammation without sequelae at five weeks [197].…”

“…Ocular manifestations are limited to retro-orbital pain, photophobia, and conjunctival injection [5]. Life-threatening complications, such as meningoencephalitis and those associated with disseminated intravascular coagulation, are rare and occur more commonly in children [197]. No specific antiviral therapies are available, and supportive care is the mainstay of treatment for this disease [199].…”

“…Topical prednisolone acetate 1% 6 times/day for anterior uveitis. Empirical IV acyclovir 10 mg/kg thrice/day was initiated for possible herpes meningoencephalitis with retinal involvement [197].…”