부산대학교 도서관

A 64-year-old man was admitted to our hospital because of acute onset of fever and impaired awareness. He showed altered levels of consciousness and neck stiffness. Cerebrospinal fluid (CSF) examination showed a marked increase in the cell count (646/mm3). He required ventilator management because of rapidly progressing disturbance of consciousness, respiratory failure and hypotension. The paired sera showed a more than a 4-fold elevation in the complement fixation titer for Japanese encephalitis virus (JEV). T2-weighted magnetic resonance imaging (MRI) images, which were obtained about 2 months after the onset of symptoms, revealed areas of abnormal intensity in the thalamus and substantia nigra. The patient was diagnosed with Japanese encephalitis (JE) on the basis of the findings of the serological tests and MRI. Two months after the onset of symptoms, the patient experienced tremors and rigidity in his left side. JE should always be considered as a differential diagnosis since the incidence of JE is expected to increase in the future because of the decrease in the vaccination rate among children in Japan and global warming.