A 52 male English farmer was brought to ED with confusion. Initially referred as expressive dysphasia, but on assessment was encephalopathic, with no focal neurological signs. A lumbar puncture was performed. WCC=0, RBC=20 Protein 890 (elevated). PCR for VZV, HSV, enteroviruse were not detected. HIV serology negative.  CT brain was normal. MRI brain is pending.

His mental status progressively worsened requiring intubation and ICU admission. He developed bilateral pulmonary effusions. intermittent fevers with neutrophilia, but liver function tests and renal function remain Normal.

He received yellow fever vaccine about 10 days prior to presentation pre-travel to Africa for a holiday.

His previous history consists of VZV related transverse  myelitis, with residual hyperreflexia (knee jerk). 17 years ago he was admitted for investigation of pyrexia of unknown origin, but no diagnosis was made at the time. 

Addendum:

attaching a power point presentation for the case