SHM Converge Scientific Abstract ePoster Gallery-Mosquito Confusion

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This case report describes a 52-year-old kidney transplant recipient who presented with acute kidney injury but later developed fever, worsening confusion, drowsiness, and delirium despite improvement in renal function. Initial brain CT and MRI were unrevealing, and he was treated empirically with broad-spectrum antimicrobials while undergoing lumbar puncture. Cerebrospinal fluid showed elevated protein, and West Nile virus (WNV) IgM was eventually detected in the CSF, confirming neuroinvasive WNV infection. He was treated with 5 days of intravenous immunoglobulin (IVIG), after which his clinical status improved and he was eventually discharged home.<br /><br />The report reviews key features of WNV infection. WNV is transmitted by mosquitoes, mainly Culex species, and has been a major mosquito-borne disease in the United States since 1999. Most infections are asymptomatic or cause mild flu-like illness, but less than 1% progress to neuroinvasive disease. In solid organ transplant recipients, infection is often much more severe, with a high rate of neuroinvasive disease and significant mortality. Typical presentation includes unexplained fever that does not respond to antibiotics, followed by rapid neurologic decline.<br /><br />Diagnostic evaluation in suspected cases should include lumbar puncture, with CSF testing for both IgM antibodies and viral nucleic acid in immunocompromised patients. MRI may be normal or show abnormalities in the basal ganglia, thalamus, or brainstem. Treatment is mainly supportive, often includes reducing immunosuppression, and may involve IVIG.<br /><br />The main takeaway is that clinicians should consider West Nile virus in patients with unexplained fever and neurologic symptoms during mosquito season, especially in organ transplant recipients.

Asset Subtitle

Shen Chen

Meta Tag

Author List Naga Doddapaneni, Shen Chen

Category Clinical Vignettes

Concept West Nile Virus

Concept Neuroinvasive Disease

Concept Immunocompromised State

Concept Solid Organ Transplant Recipient

Concept Immunoglobulin M

Distinguished Non-Finalist

Presenter Organization Emory Johns Creek Hospital

Presenting Author Shen Chen

Track Adult

Keywords

West Nile virus

neuroinvasive infection

kidney transplant recipient

acute kidney injury

cerebrospinal fluid

IgM antibodies

intravenous immunoglobulin

mosquito-borne disease

delirium

immunocompromised patient

West Nile Virus

Neuroinvasive Disease

Immunocompromised State

Solid Organ Transplant Recipient

Immunoglobulin M