Abstract Details

Title EMG Confirmed Axon Motor Polyneuropathy in a Patient with West Nile Virus: A Case Report

Topic Infectious Disease

Presentation(s) P10 - Poster Session 10 (11:45 AM-12:45 PM)

Poster/Presentation
Number 13-004

Objective We present a case report of a patient who developed acute quadriplegia in the setting of West Nile Virus (WNV) and consistent with WNV Poliomyelitis.

Background WNV induced polyneuropathy is a rare clinical scenario with few case reports documented. WNV infection with acute weakness presents as a poliomyelitis-like syndrome with acute onset of asymmetric weakness and areflexia without any sensory abnormalities. Unfortunately, patients with WNV infection who develop neuromuscular manifestations have a high rate of morbidity and mortality.

Design/Methods The patient is a 49-year-old male with no past medical history who immigrated from Mexico three days prior to presenting to our hospital with a three-day rapid worsening asymmetric weakness in all four extremities. On exam, patient was in no significant distress, however had significant flaccid tone as well as quadriplegia and areflexia in all four extremities. MRI brain and spine were unrevealing for an acute process. He was treated with five days of IVIG for presumed Guillaine-Barre (GBS), however patient failed to improve clinically and deteriorated requiring intubation for respiratory failure. Initial LP performed within 24 hours of presentation was normal. WNV antibody serum screen was however positive. EMG of the medial, ulnar, and radial nerves demonstrated a predominantly axon motor polyneuropathy and absent compound muscle action potentials (CMAP). Ultimately the patient required a tracheostomy and PEG tube. Due to lack of clinical improvement, he underwent six sessions of plasmapheresis after which his strength gradually improved to 3/5. His respiratory function improved, and he was sent to a long term assisted care facility.

Results N/a

Conclusions

Differentiating between WNV poliomyelitis and GBS is challenging. This case report emphasizes key features seen in WNV poliomyelitis such as acute onset of asymmetric weakness without sensory symptoms as well as electrodiagnostic features of motor axon loss with reduced/absent CMAPs to aide in the diagnosis.

Authors/Disclosures
Paul Partyka, DO, PhD (Nuvance Health) PRESENTER	Dr. Partyka has nothing to disclose.
Rajesh Burela, DO	Dr. Burela has nothing to disclose.
Hope Okpokam, MD	Dr. Okpokam has nothing to disclose.
Daniel E. Kaufman	Mr. Kaufman has nothing to disclose.
Sumera Javed	No disclosure on file
Yakov Isakov, DO	Dr. Isakov has nothing to disclose.
Alexandr L. Safarov, MD (Nuvance Neuroscience)	Dr. Safarov has nothing to disclose.
Paul Wright, MD, FAAN (Amwright Consulting LLC)	Dr. Wright has nothing to disclose.

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