Sensory polymyeloradiculopathy associated with Toscana virus infection

Sandfly viruses are arthropod-borne viruses that are endemic in the Mediterranean basin. The Toscana virus (TOSV) is the only serotype of sandfly viruses known to cause neurological symptoms in humans, usually aseptic meningitis or meningoencephalitis. We report a case of a 39-year-old man who was admitted to our department with progressive paresthesias of the lower limbs followed by dysesthesias of the upper thorax after a hiking trip to the Netherlands. The patient had also been suffering from epididymitis for several weeks before the neurological symptoms appeared but was treated by antibiotics accordingly. Lumber puncture results demonstrated mononuclear pleocytosis with elevated protein levels. MRI of the lumbar spine revealed polymyeloradiculopathy. Positive IgM antibodies against the Toscana serotype of sandfly virus were discovered in the patient's blood and CSF. There was also evidence for a recent infection by Mycoplasma pneumoniae. The patient was treated conservatively with improvement in his neurological state. To the best of our knowledge, this is the first case report of an association between TOSV infection and polymyeloradiculopathy.