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The hallmark clinical features of encephalitis (i.e., fever and altered mental status) are common in severely ill hospitalized patients, including persons who have undergone organ transplantation.
The California Encephalitis Project (CEP), initiated in 1998 to study the causative agents, epidemiology, and clinical features of encephalitis, has identified 20 cases of culture-confirmed tuberculous encephalitis.
In our case, the patient had the clinical features of encephalitis consisting of unremitting fever associated with a rapid course of progressive confusion and lethargy followed by coma.
When patients present with clinical features of encephalitis, viral etiologies are among the primary considerations in establishing a diagnosis, with HSV-1 and EV being among the most common offending agents [ 3, 8, 9].
Here we present a patient from Slovenia, an area highly endemic for TBE [ 8], with clinical features of encephalitis, who fulfilled criteria for recent CNS infection with TBEV although he had no CSF pleocytosis.
One patient, with biopsy-proven multiorgan IgG4-RD, developed a rapidly progressive encephalitic illness, and a diagnosis of autoimmune encephalitis was made on the basis of characteristic features of encephalitis on imaging (gadolinium magnetic resonance imaging) and cerebrospinal fluid analysis.
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Similar to the clinical features of Chandipura encephalitis (3 ), i.e., acute encephalitis with rapid onset, those reported here suggest a viral etiology.
Japanese encephalitis virus (JEV) induces neuroinflammation with typical features of viral encephalitis, including inflammatory cell infiltration, activation of microglia, and neuronal degeneration.
Typical features of limbic encephalitis include personality changes, irritability, seizures, cognitive dysfunction and memory deterioration.
The extensive limbic system involvement, lack of atrophy, presence of enhancement and extra-temporal lobe disease are possible features of limbic encephalitis and not mesial temporal sclerosis.
The outbreak features were unusual in terms of seasonality, geographical distribution, age group, and clinical manifestations in comparison to the epidemiological features of Japanese Encephalitis.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com