Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 26, 2020; 8(2): 337-342
Published online Jan 26, 2020. doi: 10.12998/wjcc.v8.i2.337
Japanese encephalitis following liver transplantation: A rare case report
Zhi-Li Qi, Li-Ying Sun, Jing Bai, Hai-Zhou Zhuang, Mei-Li Duan
Zhi-Li Qi, Li-Ying Sun, Jing Bai, Hai-Zhou Zhuang, Mei-Li Duan, Department of Intensive Care Unit, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Li-Ying Sun, Beijing Key Laboratory of Tolerance Induction and Organ Protection in Transplantation, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Author contributions: Qi ZL was the patient’s competent physician, reviewed the literature, and contributed to manuscript drafting; Bai J and Zhuang HZ were the patient’s attending physicians and contributed to manuscript drafting; Sun LY obtained informed consent and provided important intellectual content; Duan ML was responsible for revision of the manuscript; all authors gave final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Mei-Li Duan, MD, PhD, Chief Doctor, Department of Intensive Care Unit, Beijing Friendship Hospital, Capital Medical University, 95 Yong An Road, Xi Cheng District, Beijing 100050, China. 13001058598@163.com
Received: November 10, 2019
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
Abstract
BACKGROUND

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.

CASE SUMMARY

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.

CONCLUSION

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.

Keywords: Liver transplantation, Japanese encephalitis virus, Neurological complications, Infection, Case report

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.