Exploring corticosteroid therapy in tick-borne encephalitis: A case report and rationale for future research

Tick-borne encephalitis (TBE) is a viral infection of the central nervous system (CNS) caused by the tick-borne encephalitis virus (TBEV). Currently, no specific antiviral treatment exists. Corticosteroids have been proposed as a potential immunomodulatory treatment in severe cases, but their role remains controversial. This case study describes a previously healthy 54-year-old male who developed biphasic TBE with initial improvement after high-dose dexamethasone, followed by clinical deterioration after steroid discontinuation. Neurological symptoms worsened, requiring intensive care, sedation, and mechanical ventilation. Subsequent treatment with high-dose methylprednisolone was associated with rapid clinical improvement. The patient's clinical course, along with CSF findings, supports an immunopathological mechanism, possibly mediated by T cells and cytokine-induced blood-brain barrier disruption. The case aligns with literature suggesting that corticosteroids may mitigate CNS inflammation in TBE, as seen in other neuroinflammatory infections. This case highlights the potential benefit of corticosteroids in TBE.