Toscana virus infection acquired in Campania, Italy, in a Hungarian traveller: case report with mini-review

Background Toscana virus (TOSV), a sandfly-borne phlebovirus, is a leading cause of viral meningitis in the Mediterranean region and central Italy. Despite its prominence in endemic areas, TOSV infection is frequently underdiagnosed, particularly among international travellers. Case presentation A 24-year-old Hungarian male patient developed acute serous meningitis two weeks after returning from Naples, Italy. Symptoms began with a severe headache, accompanied by two episodes of vomiting. Cerebrospinal fluid (CSF) analysis showed lymphocytic pleocytosis, elevated protein, and normal glucose levels. TOSV RNA was detected in CSF by RT-PCR, and a 350-nucleotide S-segment sequence showed 99% nucleotide identity to a TOSV lineage A strain previously identified in Italy. Seropositivity in the convalescent serum sample also confirmed the acute infection. Interestingly, blood panel tests showed markedly elevated total IgE levels (437 kU/L). Conclusion To our knowledge, this represents the first molecularly confirmed case of TOSV neuroinvasive disease acquired in the Campania region since 2005. This report emphasizes TOSV as an emerging travel-associated neurotropic pathogen beyond its traditional central Italian focus, and supports the inclusion of TOSV in diagnostic panels for travellers with acute neurological symptoms following exposure in Mediterranean regions.