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Proceedings SNO “Percorsi clinici in Neuroscienze”

Case report V SESSIONE
“PERCORSI CLINICI COMPLESSI”

West Nile Virus: an atypical presentation

A. LANARI*, S. SQUARZA**

* Unit of Neurology, ASST Grande Ospedale Metropolitano “Niguarda”, Milan, Italy
** Unit of Neuroradiology, ASST Grande Ospedale Metropolitano “Niguarda”, Milan, Italy

INTRODUCTION tacrolimus and mycophenolate (MMF), epilepsy
(therapy with levetiracetam), diabetes mellitus. Neu-
West Nile Virus is an arthropod-borne virus (Arbo- rologic exam was almost normal. The patient was ad-
virus) transmitted by mosquitoes. mitted to the Medical Care. Serum laboratory testing
Originally described in 1937 and named for its region revealed mild thrombocytopenia, normal inflamma-
of discovery in the West Nile district of Uganda, tion indices, persistent fever. In Medical Care Unit
WNV emerged in the Western Hemisphere in the US therapy was started with broad spectrum antibiotic af-
and then in Europe in the summer of 1999. WNV is ter the blood and urine culture; basal radiological ex-
maintained in nature in an enzootic cycle between in- ams was normal. After two days patient condition got
vertebrates (mosquitoes) and vertebrates, mainly worse with non epileptic tremor at arms and lowering
birds, although equids and humans are accidental of vigilance. Physical examination of the patient was
hosts as they are inadequate to maintain the virus cy- significant for tremor at rest, axial rigidity, absence of
cle. However, since morbidity and mortality are ob- language, lethargy (not pyramidal signs, not nuchal
served in both species, these infections have a great rigor). An electroencephalogram was negative for
economic and human health repercussion and spo- any epileptiform activity and sowed diffuse slowing.
radic transmission has also been documented by For a sudden worsening of his clinical condition we
blood transfusions and transplants in humans, or by performed a brain MR who demonstrated non specif-
transplacental routes. Prevention plays a very impor- ic bilateral subcortical and deep white matter abnor-
tant role to reduce the impact of WNV and, by now, malities, without DWI restriction or pathological en-
the most efficient strategy to avoid infection is to hancement; a mild hyperintensity of insular cortex
elude mosquito bites. was also observed. He was transferred to the inten-
sive care unit and intubated for airway protection.
CSF analysis showed a high level of protein (170
CASE REPORT mg/dL) and leukocytosis (35 cells), glucose normal
level, negative viral PCR (JC, Herpes Simplex 1-2-6;
We present a case of a 69 years old man who pre- Epstein Barr, Varicella Zoster, Citomegalovirus, En-
sented at our Emergency Department for asthenia, terovirus), negative bacteria, HIV, Borrelia. A second
fever and diarrhea for a week; for a day mild disori- MR performed 4 days later did not show significant
entation. The medical history was characterized by changes compared with the patient neurological
liver transplantation (one year ago) on therapy with worsening.

Corrispondenza: Dr.ssa Alessia Lanari, UO di Neurologia, ASST Grande Ospedale Metropolitano Niguarda, piazza dell’Ospedale
Maggiore 3, 20162 Milano (MI), e-mail: alessia.lanari@ospedaleniguarda.it
Percorsi clinici in Neuroscienze. Clinical Round SIN e SNO Lombardia, 21 gennaio 2022, Desio (Monza e Brianza)
Atti a cura di Paolo Ferroli, Alessandra Protti, Andrea Salmaggi, Ignazio Michele Santilli, Luca Valvassori
Copyright © 2022 by new Magazine edizioni s.r.l., Trento, Italia. www.newmagazine.it ISBN: 978-88-8041-135-2

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