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Yellow fever vaccine-associated neurological disease, a suspicious case
  1. Pedro Beirão1,
  2. Patrícia Pereira1,
  3. Andreia Nunes1,
  4. Pedro Antunes2
  1. 1Department of Internal Medicine, Hospital Garcia de Orta, Almada, Portugal
  2. 2Endocrinology department of the Portuguese Oncology Institute, Lisbon, Portugal
  1. Correspondence to Dr Pedro Beirão, pbeirao{at}


A 70-year-old man with known cardiovascular risk factors, presented with acute onset expression aphasia, agraphia, dyscalculia, right-left disorientation and finger agnosia, without fever or meningeal signs. Stroke was thought to be the cause, but cerebrovascular disease investigation was negative. Interviewing the family revealed he had undergone yellow fever vaccination 18 days before. Lumbar puncture revealed mild protein elevation. Cultural examinations, Coxiella burnetti, and neurotropic virus serologies were negative. Regarding the yellow fever virus, IgG was identified in serum and cerebrospinal fluid (CSF), with negative IgM and virus PCR in CSF. EEG showed an encephalopathic pattern. The patient improved gradually and a week after discharge was his usual self. Only criteria for suspect neurotropic disease were met, but it's possible the time spent between symptom onset and lumbar puncture prevented a definite diagnosis of yellow fever vaccine-associated neurological disease. This gap would have been smaller if the vaccination history had been collected earlier.

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  • Contributors PB participated in bibliographic research, manuscript writing. PP was involved in admittance to the emergency room data collection and manuscript review. AN was involved in patients follow-up consult and manuscript review. PA was involved in the daily management of the patient during his stay at our ward, and contributed to manuscript review.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.