Published online Jan 26, 2020. doi: 10.12998/wjcc.v8.i2.337
Peer-review started: November 10, 2019
First decision: November 19, 2019
Revised: November 25, 2019
Accepted: December 6, 2019
Article in press: December 6, 2019
Published online: January 26, 2020
Japanese encephalitis (JE) is a serious public health concern with a high mortality rate in many Asian countries. For many years, JE virus (JEV) was considered the major cause of viral encephalitis in Asia. Although most JE cases are asymptomatic, the case fatality rate approaches 30%, and approximately 30%–50% of survivors have long-term neurological sequelae. To the best of our knowledge, JEV infection has never been reported following liver transplantation.
We report a case of a woman who underwent liver transplantation for autoimmune liver disease but presented with fever and neurological symptoms 13 d after transplantation. Magnetic resonance imaging revealed JEV infection, and positive immunoglobulin M antibody to JEV in blood and cerebrospinal fluid confirmed JE. The patient was treated with antiviral agents, immune regulation, and organ function support. No neurological sequelae were present after 1 year of follow-up.
Imaging and lumbar puncture examination should be performed as soon as possible in patients with fever and central nervous system symptoms after liver transplantation, and the possibility of atypical infection should be considered, which is helpful for early diagnosis and improved prognosis.
Core tip: Japanese encephalitis is a serious public health concern with a high mortality rate in many Asian countries. We describe a rare case of a woman who underwent liver transplantation and was subsequently diagnosed with Japanese encephalitis. This case highlights the need for performing imaging and lumbar puncture examination as soon as possible in patients with fever and central nervous system symptoms after liver transplantation.