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05.02.2024 | images in clinical medicine

Image in clinical medicine

Scapular winging in tick-borne encephalitis

verfasst von: Tamara Garibashvili, Katharine Kämpchen, Prof. Dr Josef G. Heckmann, MME

Erschienen in: Wiener klinische Wochenschrift

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Excerpt

A 46-year-old man presented with increasing general weakness, fever and headache. He described a tick bite 2 weeks previously. Clinically, the patient had mild neck stiffness and psychomotor slowing. His body temperature was 39.5 °C. Magnetic resonance imaging (MRI) revealed normal findings for the meninges, brain and spinal cord. Cerebrospinal fluid showed lymphocytic pleocytosis (64 cell per µl, normal <4 per µl) and antibodies against tick-borne encephalitis virus (TBEV, antibody-specific index 4.3, normal < 1.2). Antibodies against Borrelia, herpes simplex and varicella zoster virus were normal. Over 5 days, the patient had persistent fever spikes with a marked malaise. On day 6, the patient reported new pain and paresthesia in the right shoulder girdle. He went on to develop prominent scapular winging on the right side (Fig.  1). We diagnosed an infection with TBEV associated with peripheral nerve damage and marked scapular winging. At a follow-up examination 5 months later, the scapular winging persisted. The patient continued to receive physiotherapy and low-dose pain medication with pregabalin.
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Metadaten
Titel
Image in clinical medicine
Scapular winging in tick-borne encephalitis
verfasst von
Tamara Garibashvili
Katharine Kämpchen
Prof. Dr Josef G. Heckmann, MME
Publikationsdatum
05.02.2024
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-024-02330-8