Tick-borne encephalitis complicated by monoplegia and sensorineural deafness

Tick-borne encephalitis (TBE) is rarely seen in Britain. We report a case of TBE in a 44-year-old Swedish woman presenting to an accident and emergency department in London. The clinical features of the case, while in many ways typical, were nonspecific and led to difficulty in early diagnosis. The course of the illness was complicated by monoplegia and evidence of bulbar involvement with sensorineural deafness. The last is a very rare manifestation of TBE. With increasing foreign travel, TBE is likely to present more commonly in the U.K. and should be considered in any case of febrile illness with neurological complications following travel abroad. Serological tests to aid early diagnosis should be more readily available.