Tick borne encephalitis (TBE) virus causes the most important arthropod transmitted disease in central Europe. In endemic areas, TBE has an incidence of 1.2 per 10 000 and a mortality of approximately 1%. The TBE virus is a neurotropic human pathogen. The most common presentations are meningitis (49%), meningoencephalitis (41%) and meningoencephalomyelitis (10%).¹ Patients with concomitant spinal cord involvement are thought to be affected more severely and mechanical ventilation is often necessary.²

We present an unusual TBE case with an isolated myelitis without signs of meningitis or meningoencephalitis.

Case report

A 43-year-old man from the Black Forest area, Germany, who had not had TBE vaccination developed symptoms of gastroenteritis with fever (diarrhoea, nausea and vomiting) lasting for approximately 1 week. Two days after recovery from the gastrointestinal symptoms he experienced severe pain in his shoulders followed by proximal pareses of his brachial muscles without signs of meningism. As the symptoms were not ameliorating during the following days, the patient was admitted to hospital. At that time he had severe pareses of the upper extremities …