Abstract
West Nile Virus (WNV), an RNA arbovirus and member of the Japanese encephalitis virus antigenic complex, causes a wide range of clinical symptoms, from asymptomatic to encephalitis and meningitis. Nearly all human infections of WNV are due to mosquito bites with birds being the primary amplifying hosts. Advanced age is the most important risk factor for neurological disease leading most often to poor prognosis in those afflicted. We report a case of WNV meningoencephalitis in a 93-year-old Caucasian male who presented with fever of unknown origin (FUO) and nuchal rigidity that rapidly decompensated within 24 h to a persistent altered mental state during inpatient stay. The patient's ELISA antibody titers confirmed pathogenesis of disease by WNV; he given supportive measures and advanced to an excellent recovery. In regard to the approach of FUO, it is important to remain impartial yet insightful to all elements when determining pathogenesis in atypical presentation.
Highlights
West Nile Virus (WNV), an RNA arbovirus and member of the Japanese encephalitis virus antigenic complex, causes a wide range of clinical symptoms, from asymptomatic to encephalitis and meningitis
We report a case of WNV meningoencephalitis in a 93-year-old Caucasian male who presented with fever of unknown origin (FUO) and nuchal rigidity that rapidly decompensated within 24 h to a persistent altered mental state during inpatient stay
West Nile Virus (WNV) has produced 3 of the largest arboviral neuroinvasive disease outbreaks ever recorded in the United States, with persistently high number of cases up to 3000 in 2002, 2003, and 2012 [1]
Summary
History of present illness is significant for a hospital admission one month prior with admitting diagnosis of FUO and dehydration. The patient was discharged with systemic inflammatory response syndrome (SIRS) of unknown etiology and treated outpatient with a course of clindamycin. Past medical history is significant for SIRS of unknown etiology, hypertension, acute renal failure, and osteoarthritis of the neck and knee. History was noncontributory; social history revealed he was a retired veteran who lived at home with his wife. He denied recent travel and denied tobacco or alcohol use. The patient review of systems was negative except for fevers, chills, dizziness, constipation, neck pain, stiffness, and left knee crepitus with occasional joint pain and decreased range of motion. A thorough evaluation was commenced to determine the cause of meningitis and as cause of infection was unknown, empirical treatment was begun
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