Neurological involvement in two phases of Kyasanur Forest Disease

Kyasanur Forest Disease (KFD) is a tick-borne viral illness endemic to Southern India, often categorized as viral haemorrhagic fever, though its biphasic neurological involvement is less frequently discussed. We present the case of an elderly woman from Karnataka, India, who initially presented with fever and altered sensorium, diagnosed with the first phase of KFD and treated with supportive care for ten days. Four weeks later, she returned with second-phase manifestations of fever, headache, neck stiffness and lymphocytic pleocytosis on cerebrospinal fluid analysis. We report this case to emphasize the need for high suspicion of KFD in patients presenting with neurological symptoms in the endemic regions.