Open AccessWest Nile encephalitis, status epilepticus and West Nile pneumonia in a renal transplant patient
Author(s) -
Jain Nitin,
Fisk David,
Sotir Mark,
Kehl Karen S.
Publication year - 2007
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/j.1432-2277.2007.00514.x
Subject(s) - medicine , status epilepticus , encephalitis , viral encephalitis , immunology , pneumonia , transplantation , west nile virus , cerebrospinal fluid , virology , virus , epilepsy , psychiatry
Summary West Nile neuroinvasive disease (WNND) represents a small fraction of cases of West Nile Virus (WNV) infection. Organ transplantation is associated with increased risk of acquiring WNND. We report a patient with living‐related renal transplantation who developed unusual manifestations of WNND. First, fatal status epilepticus unresponsive to pentobarbital ensued. Status epilepticus from WNV has been described very rarely in the medical literature. Second, this patient grew WNV on broncho‐alveolar lavage samples. To our knowledge, this is the first case of culture positive West Nile pneumonia. Third, the finding in cerebrospinal fluid (CSF) of a negative West Nile immunoglobulin M (IgM) and a positive West Nile polymerase chain reaction is striking. It is consistent with a high‐viral burden and impaired immune response. This finding raises questions about the appropriateness of relying on CSF IgM assays to rapidly diagnose WNV encephalitis in organ transplant patients, as has been recommended.