Highlights

    •First case of fatal encephalitis caused by zika infection in adult.
    •IgM zika antibody detected in both serum and CSF, positive zika PCR in urine.
    •Existence of blood-CSF barrier dysfunction and intrathecal antibody synthesis.
    •Viral aggressive involvement of central nervous system docuмented in adult.
    •Need for an efficient surveillance for severe neurological cases.

Abstract
Background

Zika virus (ZIKV) was first identified in the Americas in 2015, when an outbreak of an exanthematous illness occurred in Brazil. Subsequentely, there was an increase of microcephaly cases, suggesting an association between ZIKV and this neurological complication. Currently, ZIKV has been recognized as causing a wide range of neurological complications including Guillain Barré syndrome, and myelitis.
Objectives

In this report, we describe the first fatal case of encephalitis in a 47 years old non pregnant woman, infected during the Brazilian zika epidemic of 2016.
Study Design

The diagnosis of encephalitis was determined by the presence of a disturbed level of consciousness and focal neurological signs during an exanthemous viral infection.
Results

CSF analysis supported the diagnosis of viral encephalitis, revealing lymphocytic pleocytosis, a high protein concentration, and the presence of IgM zika antibodies. RT-PCR analysis for ZIKV was positive in the urine. A brain computed tomography showed massive brain swelling. Our case differs from previous reports, because her neurological picture developed rapidly and in a very aggressive manner leading to brain death after eleven days of admission.
Conclusion

In endemic areas, ZIKV should be considered as an aetiological agent in cases of encephalitis, and clinicians should be aware of its potential severity.