Toscana virus encephalitis with reversible self-limiting vasculopathy

Toscana virus (named after Tuscany, Italy) is an arthropod borne virus transmitted by sandflies. It is common in the Mediterranean region, several southern European countries and some North African countries, but is rare in the UK. Most Toscana virus infections are asymptomatic, but severe infections can have neurological manifestations. Toscana virus encephalitis is an uncommon self-limiting encephalitis with a vasculopathy. We report an elderly man who developed Toscana virus encephalitis and vasculopathy causing multiple ischaemic strokes with evidence of reversible intravascular stenosis, after a brief holiday on a Mediterranean cruise. The diagnosis is confirmed by detecting the presence of the virus in the cerebrospinal fluid (CSF) using real-time reverse transcriptase - PCR (RT-PCR) tests, and by a rise in antibody titres in serum. The treatment of Toscana virus infections is mainly symptomatic. Toscana virus infection should be considered in returning travellers who develop a febrile illness with confusion.