SHM Converge Scientific Abstract ePoster Gallery-Beltline Bite: A Case of West Nile Virus in the Heart of Atlanta

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This case describes a 54-year-old woman in Atlanta who presented with fever, diffuse macular rash, truncal pain, and rapidly progressive bilateral lower-extremity weakness after frequent mosquito exposure on the Beltline. Exam showed severe leg weakness, reduced vibration sense, and preserved reflexes. Initial workup was notable for mild thrombocytopenia, normal inflammatory markers, and MRI evidence of extensive thoracic spinal cord signal abnormality consistent with transverse myelitis. Cerebrospinal fluid showed lymphocytic pleocytosis, elevated protein, and normal glucose, supporting an infectious inflammatory process.<br /><br />She was initially treated with high-dose steroids for presumed transverse myelitis and closely monitored with serial negative inspiratory force testing because of concern for ascending weakness and possible diaphragmatic involvement. She also developed urinary retention requiring Foley catheter placement and was transferred to the ICU. After additional treatment with plasmapheresis, CSF PCR confirmed West Nile virus infection. She was ultimately discharged to acute rehabilitation.<br /><br />The discussion highlights that West Nile virus is the leading mosquito-borne illness in the continental United States and can present with variable neurologic syndromes, including meningoencephalitis, flaccid paralysis, respiratory failure, and transverse myelitis. Although most infections are asymptomatic or mild, about 1% progress to neuroinvasive disease, and these cases can carry substantial morbidity and a mortality rate of about 10%. Risk factors for severe disease include older age and B-cell depleting therapies. There is no specific antiviral treatment or vaccine; management is supportive, and mosquito avoidance remains the main prevention strategy.<br /><br />The key teaching point is that clinicians in Atlanta and similar endemic areas should maintain suspicion for West Nile virus even without travel or major outdoor exposure when evaluating unexplained neurologic symptoms.

Asset Subtitle

Jesse D. Gruber

Meta Tag

Author List Brandon Davis, Jesse D. Gruber, Nikita Deng, Shruti Erramilli, Yoo Mee Shin

Category Clinical Vignettes

Concept West Nile Virus

Concept Neuroinvasive Disease

Concept Respiratory Failure

Concept Supportive Care

Concept Mosquito-borne Disease

Distinguished Finalist

Presenter Organization Emory University School of Medicine

Presenting Author Jesse D. Gruber

Track Adult

Keywords

West Nile virus

transverse myelitis

mosquito-borne illness

neuroinvasive disease

Atlanta

bilateral lower-extremity weakness

cerebrospinal fluid pleocytosis

respiratory failure

plasmapheresis

acute rehabilitation

West Nile Virus

Neuroinvasive Disease

Respiratory Failure

Supportive Care

Mosquito-borne Disease