Coma Following TBE Virus Infection in a Child

A 13-year-old previously healthy, immunocompetent girl was admitted with bimodal symptoms including fever, headache, limb pain, inability to walk, and decreased alertness. A few days earlier, the patient had been found to have a tick bite. The day after her admission, the girl suffered recurrent seizures, and emergency intubation and intensive medical care were performed due to the absence of respiratory drive. In the further course, increasing autonomic dysregulation with blood pressure fluctuations and an increase in intracranial pressure was seen, as a result of which bilateral hemicraniectomy was performed. At present, a syndrome of unresponsive wakefulness persists.

Figure

Axial FLAIR MRI

Patient history, symptoms, TBE IgM-positive serum, and cMRT findings were immediately suggestive of viral tick-borne encephalitis (TBE). The diagnosis was confirmed some days later by the detection of TBE IgG seroconversion. The incidence of TBE is 0.7–2/100 000 population. Severe TBE encephalomyelitis causes neurological damage in 50% of affected persons, and 30% die due to the effects of the disease. Differential diagnoses include, for example, herpes encephalitis and Lyme disease. There is no targeted treatment. The German Standing Commission on Vaccination (STIKO) recommends vaccinations from the age of 2 years in at-risk regions (see the German Association of Scientific Medical Societies [AWMF] guideline). We should fulfill our duty to inform patients in expanding endemic areas.

Dr. med. Leonie Zerweck, PD Dr. med. Benjamin Bender, Abteilung Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum Tübingen, [e-mail]

Dr. med. Andrea Bevot, Abteilung Neuropädiatrie, Entwicklungsneurologie, Sozialpädiatrie, Universitätsklinikum Tübingen

Conflict of interest statement: The authors declare that no conflict of interests exists.

Translated from the original German by Christine Rye.

Cite this as: Zerweck L, Bevot A, Bender B: Coma following TBE virus infection in a child. Dtsch Arztebl Int 2023; 120: 612. DOI: 10.3238/arztebl.m2023.0188