Abstract
SESSION TITLE: Wednesday Fellows Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: West Nile Virus (WNV) is an arthropod-borne Flavivirus that was first documented in the United States in 1999. While neuroinvasive manifestations of WNV infection are well-described worldwide, pulmonary complications are exceedingly rare and more commonly reported in Africa. We present a unique case of diffuse alveolar hemorrhage (DAH) secondary to WNV infection. CASE PRESENTATION: A 76-year-old Caucasian male with a past medical history of coronary artery disease status post bypass graft, atrial fibrillation on anticoagulation, and recent diagnosis of WNV encephalitis presented with progressive respiratory failure. The patient’s encephalitis was diagnosed one month prior based on elevated cerebrospinal fluid (CSF) titers including WNV IgM 7.48 and IgG 0.29. Serum titers of WNV IgM and IgG were also elevated to 9.48 and 2.87, respectively. He was intubated during that admission for respiratory failure and altered mental status with a prolonged ventilation period. The patient ultimately required tracheostomy and was discharged to a long-term acute care facility. Six days after discharge, the patient re-presented to our facility with increased ventilator requirements and respiratory distress. On Hospital Day # 2, the patient demonstrated worsening infiltrates on imaging, acute-onset anemia, and frank hemoptysis from tracheostomy. Bronchoscopic exam was consistent with DAH. Bronchial angiography was performed but no abnormalities were identified to be amenable to embolization. Additional work-up was negative for ANCA vasculitis, leptospirosis or other infectious agents, and Goodpasture syndrome. His therapeutic heparin was held and intravenous protamine and inhaled tranexamic acid were administered. High-dose (1 Gram/Day) methylprednisolone was also initiated for 3 days with a prolonged taper thereafter. On Hospital Days # 4 and 6, repeat bronchoscopy was performed with improved but persistent pulmonary hemorrhage noted. The patient continued to improve over the following two weeks and a final bronchoscopic assessment near time of discharge was unremarkable for hemorrhage. DISCUSSION: Our patient developed a clinically significant pulmonary hemorrhage that is most strongly supported by WNV infection. Following inoculation, the virus first spreads to regional lymph nodes, spleen, and reticuloendothelial cells. It is theorized that viral localization or replication in the vascular endothelium leads to microvascular damage and resultant hemorrhage. CONCLUSIONS: Pulmonary complications of WNV infection are rare but should be considered in a patient with progressive respiratory failure and/or DAH. High-dose systemic steroids and inhaled tranexamic acid may be beneficial in WNV-related DAH. Reference #1: Avasthi D, Al-Dabbas M, Avasthi S. Pulmonary Alveolar Hemorrhage a Complication of West Nile Fever. Infect Dis Clin Pract. 2016 May; 24(3):e9-e10. Reference #2: Paddock CD, Nicholson WL, Bhatnagar J, et al. Fatal hemorrhagic fever caused by West Nile virus in the United States. Clin Infect Dis. 2006 Jun 1;42(11):1527-35. DISCLOSURES: No relevant relationships by Philip Hanneman, source=Web Response No relevant relationships by Farzad Loghmani, source=Web Response
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call