SHM Converge Scientific Abstract ePoster Gallery-An Elusive Masquerader: A Rare Presentation of Generalized Weakness

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This case report describes a 69-year-old woman with diabetes, atrial fibrillation, and hypothyroidism who was hospitalized in August 2023 with fever, lethargy, headache, photophobia, generalized weakness, and worsening encephalopathy. She initially presented to urgent care and was discharged with a presumed viral upper respiratory infection, but her condition deteriorated despite empiric antibiotics and antivirals.<br /><br />Her evaluation was largely unrevealing at first: blood cultures were negative, MRI of the brain was normal, and echocardiography showed no vegetations. Because of progressive neurologic decline, neurology was consulted and a lumbar puncture was performed. Cerebrospinal fluid showed pleocytosis, elevated protein, and a negative meningitis/encephalitis PCR panel. Six days after admission, West Nile virus antibody testing returned positive, confirming West Nile meningitis. Antibiotics were discontinued, supportive care was continued, and she was discharged to subacute rehabilitation with neurology follow-up.<br /><br />The report emphasizes that West Nile virus infection is commonly asymptomatic, and fewer than 1% of symptomatic cases develop neuroinvasive disease. This patient’s presentation was unusual because of both the severity of generalized weakness and encephalopathy and the fact that the disease occurred in a region not traditionally considered a high-incidence area. Her gardening during spring and summer may have increased mosquito exposure.<br /><br />The authors conclude that West Nile virus should be considered in patients with summer/fall fever, progressive neurologic symptoms, and rapid clinical deterioration, even when early testing is nonspecific. The case highlights the risk of diagnostic delay and the importance of awareness of local outbreak patterns and updated surveillance data.

Asset Subtitle

Aakash Patel

Meta Tag

Author List Aakash Patel, Ebtisam Alumin Osman

Category Clinical Vignettes

Concept West Nile Virus

Concept Neuroinvasive Disease

Concept Cerebrospinal Fluid Studies

Concept Encephalopathy

Concept Meningitis

Distinguished Non-Finalist

Presenter Organization Wellstar Kennestone Regional Medical Center

Presenting Author Aakash Patel

Track Adult

Keywords

West Nile virus

West Nile meningitis

encephalopathy

fever

lumbar puncture

cerebrospinal fluid pleocytosis

neuroinvasive disease

mosquito exposure

diagnostic delay

case report

West Nile Virus

Neuroinvasive Disease

Cerebrospinal Fluid Studies

Encephalopathy

Meningitis