SHM Converge Scientific Abstract ePoster Gallery-West Nile Virus Encephalitis Complicated by Facial Diplegia and Guillain-Barre Syndrome: A Diagnostic Challenge

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This report describes a diagnostic challenge in a patient with West Nile virus (WNV) encephalitis who later developed bilateral facial weakness and Guillain–Barré syndrome (GBS)-like features. WNV is a leading cause of neuroinvasive arboviral disease in the United States, and cranial nerve involvement can occur, though facial diplegia is rare. Because WNV can directly affect the nervous system or trigger an immune-mediated neuropathy such as GBS, distinguishing between these possibilities is difficult.<br /><br />The patient initially presented on day 0 with fever, confusion, and neck stiffness. Lumbar puncture supported WNV encephalitis, brain MRI was normal, and EEG showed diffuse slowing. He received supportive care, and encephalopathy improved over several days. On hospital days 10–11, he developed new right facial paralysis progressing to facial diplegia. Repeat lumbar puncture showed albuminocytologic dissociation, and lumbar MRI demonstrated mild diffuse cauda equina enhancement. Although nerve conduction studies and EMG were initially normal, these later findings strongly suggested an immune-mediated GBS-spectrum process rather than only direct viral neurotropism.<br /><br />Intravenous immunoglobulin (IVIG) was started on day 12 at 0.4 g/kg/day for 5 days. Facial weakness began improving within 72 hours of treatment. By discharge on day 18, cognition had returned to baseline and facial function was recovering.<br /><br />The case highlights that delayed neurologic worsening during recovery from WNV should prompt reconsideration of GBS, even when early electrophysiology is unrevealing. CSF analysis, MRI, and repeat clinical examination were key to diagnosis. The report emphasizes that IVIG is standard therapy for GBS, while no effective antiviral treatment exists for WNV.

Asset Subtitle

Maria Carolina Musri

Meta Tag

Author List Abdullah Al-Owesie, Catherine Washburn, Manasa Srivillibhuthur, Maria Carolina Musri

Category Clinical Vignettes

Concept Neuroinvasive Disease

Concept Guillain-Barré Syndrome

Concept West Nile Virus

Concept Cranial Neuropathy

Concept Encephalitis

Distinguished Non-Finalist

Presenter Organization Johns Hopkins University

Presenting Author Maria Carolina Musri

Track Adult

Keywords

West Nile virus

encephalitis

bilateral facial weakness

Guillain-Barré syndrome

facial diplegia

albuminocytologic dissociation

cauda equina enhancement

intravenous immunoglobulin

neuroinvasive arboviral disease

cranial nerve involvement

Neuroinvasive Disease

Guillain-Barré Syndrome

West Nile Virus

Cranial Neuropathy

Encephalitis