# Extraneurological Presentations of Tick‐Borne Encephalitis Virus: A Rare Case of TBEV‐Associated Myocarditis With Fever and Bicytopenia and a Systematic Literature Review

## TL;DR

This paper reports a rare case of tick-borne encephalitis virus (TBEV) causing myocarditis and reviews other non-neurological TBEV cases in the literature.

## Contribution

The paper presents a novel case of TBEV-associated myocarditis and systematically reviews extraneurological TBEV manifestations.

## Key findings

- TBEV can cause myocarditis, a rare extraneurological complication.
- A systematic review identified 23 cases of non-neurological TBEV manifestations.
- TBEV-related complications include myositis, hematological issues, and elevated transaminases.

## Abstract

Tick‐borne encephalitis (TBE), a zoonotic disease caused by the tick‐borne encephalitis virus (TBEV), usually manifests with a biphasic course with neurological involvement during its second phase. Extraneurological manifestations are rare but clinically relevant.

We report a case of a 77‐year‐old patient with suspected acute myocarditis associated with central European TBEV infection and summarize the literature on extraneurological TBEV manifestations through a systematic review.

The case of a 77‐year‐old patient with suspected acute myocarditis associated with central European TBEV infection is reported and discussed. Literature analysis identified 23 publications reporting extraneurological TBEV manifestations, including (peri)myocarditis, myositis, hematological abnormalities, and elevated transaminases.

TBEV infection can be complicated by myocarditis and should therefore be considered in the differential diagnosis in areas where TBEV is endemic in a patient with risk factors for tick bites. Vaccination remains crucial for preventing TBEV infections.