Abstract
Eastern equine encephalitis (EEE) is a severe arboviral neuroinvasive disease with high mortality and neurological sequelae. Treatment for EEE is primarily supportive. Intravenous immunoglobulin (IVIg) and high-dose steroids have been used as empirical therapy for EEE with some case reports of benefit. We report a case of a patient who presented with encephalopathy with initial cerebrospinal spinal fluid (CSF) serology analysis showing California serogroup encephalitis virus IgG positivity. However, the rapid clinical deterioration of the patient into a comatose state prompted a second CSF serology analysis that showed seroconversion of high titer Eastern Equine Encephalitis virus IgM and positive titer of California serogroup encephalitis virus IgG. The patient completed a 5-day course of empiric IVIg without concurrent corticosteroid therapy but did not show significant clinical improvement.
Highlights
Eastern equine encephalitis (EEE) is the most severe arboviral disease with >35% mortality in humans, especially in the 50 year-old populations [1,2,3,4]
Recent case reports of possible positive outcome from empiric Intravenous immunoglobulin (IVIg) and high-dose IV methylprednisolone (1 g/day) in EEE
Suggest that a part of the neuropathology associated with equine encephalitis virus (EEEV) infection may be due to the inflammatory reaction in the brain
Summary
Eastern equine encephalitis (EEE) is the most severe arboviral disease with >35% mortality in humans, especially in the 50 year-old populations [1,2,3,4]. On hospital day 4, neurological exam in the setting of pharmacologic sedation and mechanical ventilation was significant for a comatose state with absent brainstem reflexes except for bilateral positive corneal reflexes She withdrew to painful stimuli in the upper extremities but not lower extremities. During clinic follow-up 6 weeks post-IVIg trial completion, neurological exam showed an awake state with spontaneous eye opening, presence of bilateral blink to threat, intact corneal reflexes, and withdrawal to noxious stimuli in all extremities. She was non-verbal, unable to follow simple instructions, unable to walk, and completely dependent in her activities of daily living
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