SHM Converge Scientific Abstract ePoster Gallery-Wild, Wild West Nile: A Meningoencephalitis Patient With Ocular Complications

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This case report describes a 35-year-old woman who developed West Nile virus (WNV) neuroinvasive disease after attending an outdoor wedding in rural Iowa during the summer. She initially presented with 5 days of severe headache, neck pain, fever, nausea, vomiting, and a petechial rash. Early imaging was unrevealing, and she was treated empirically for possible tick-borne illness and aseptic meningitis. As her illness evolved, she developed focal neurologic findings, including facial asymmetry and upper extremity weakness, and repeat MRI showed bilateral basal ganglia abnormalities. <br /><br />A dilated eye exam later revealed an intraretinal hemorrhage in the right macula, and she subsequently developed central blindness in the right eye. CSF and serum testing confirmed WNV infection. Antiviral and doxycycline therapy were discontinued, and she improved with supportive care before discharge.<br /><br />The report emphasizes that WNV neuroinvasive disease can present as meningitis, encephalitis, acute flaccid paralysis, cranial nerve palsies, and ocular disease. Chorioretinitis and other eye findings may be important clues to diagnosis, especially when systemic symptoms are present. Because WNV is often underdiagnosed and most cases occur in summer months or after travel to high-incidence areas, clinicians should maintain a low threshold to test for WNV in appropriate patients. The main treatment remains supportive care, with attention to symptom control and pain management.

Asset Subtitle

Rachel Maurer

Meta Tag

Author List Nicole Cho, Rachel Maurer

Category Clinical Vignettes

Concept West Nile Virus Neuroinvasive Disease

Concept Clinical Suspicion

Concept Supportive Treatment

Concept West Nile Virus Meningoencephalitis

Concept Meningitis

Distinguished Non-Finalist

Presenter Organization Rush Medical College

Presenting Author Rachel Maurer

Track Adult

Keywords

West Nile virus

neuroinvasive disease

chorioretinitis

meningitis

encephalitis

acute flaccid paralysis

cranial nerve palsy

intraretinal hemorrhage

basal ganglia abnormalities

supportive care

West Nile Virus Neuroinvasive Disease

Clinical Suspicion

Supportive Treatment

West Nile Virus Meningoencephalitis

Meningitis