Unusual cause at an unusual time—Powassan virus rhombencephalitis

Powassan virus lineage II (POWV) is an emerging tick-borne neurotropic pathogen, transmitted to humans by the bite of infected Ixodes scapularis ticks. In United States, disease most prevalent in Northeast and upper Midwest occurs mostly during spring summer months when tick activity highest. Some patients with POWV develop severe encephalitis, high mortality. We report case a 42-year-old healthy man who developed progressive diplopia dysarthria December following deer hunting trip. Routine blood work was unrevealing MRI normal. Extensive work-up for infectious, autoimmune, paraneoplastic causes positive only POWV. The patient treated supportive care intravenous corticosteroids, excellent outcome. present rare clinical presentation potentially fatal that responded favorably corticosteroids.