Abstract Details

Title West Nile Virus Meningoencephalitis Presenting with Seizures in an Immunosuppressed Patient

Topic Infectious Disease

Presentation(s) P11 - Poster Session 11 (11:45 AM-12:45 PM)

Poster/Presentation
Number 3-004

Objective To describe an atypical presentation of West Nile virus (WNV) neuroinvasive disease in an immunosuppressed patient with focal seizures, and to highlight diagnostic and management considerations.

Background

WNV is a mosquito-borne virus. It can lead to severe brain disease, especially in older adults or those with weak immune systems. Clinical manifestations range from meningitis and encephalitis to poliomyelitis-like paralysis. Seizures are uncommon and may delay diagnosis.

Design/Methods

Single case report of a 57 year old man with end stage renal disease on hemodialysis and chronic immunosuppression (tacrolimus, prednisone) who developed focal seizures and encephalopathy. Data were collected from clinical history, examination, cerebrospinal fluid (CSF) analyses, imaging, and serologic testing.

Results The patient presented with right arm clonic seizures that generalized, followed by progressive confusion and weakness. Initial CSF revealed 350 WBC/µL (96% neutrophils), elevated protein, and normal glucose; cultures and viral PCRs were negative. Brain MRI showed diffuse T2/FLAIR hyperintensities without enhancement. Despite broad antimicrobial therapy, his condition worsened, requiring intubation. Repeat CSF demonstrated lymphocytic shift, and WNV IgM antibodies were positive in both serum and CSF, confirming the diagnosis. Ophthalmologic evaluation revealed chorioretinitis, and persistent right arm weakness suggested anterior horn cell involvement. He improved gradually with supportive management, seizure control, and immunosuppression tapering.

Conclusions WNV should be considered in patients with unexplained encephalitis and seizures, especially in immunocompromised individuals during mosquito season. Early neutrophilic CSF, diffuse MRI findings, and systemic features such as retinitis or flaccid weakness may suggest WNV infection. Prompt recognition prevents unnecessary antimicrobial use and guides supportive management.

Authors/Disclosures
Jagjot Singh, MBBS PRESENTER	Dr. Singh has nothing to disclose.
Ramanjot Kaur, MBBS	Dr. Kaur has nothing to disclose.
Harneel S. Saini, DO (Allegheny General Hospital)	Dr. Saini has nothing to disclose.

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