West nile virus case studies
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Michael Maddaleni, B.S.
Case 1 overview
The first case presented displays a rare complication associated with West Nile Virus. Commonly, West Nile Virus is associated with neuro-invasive disorders, but there is also a tendency for it to cause myocarditis[1]. It has become apparent that physicians need to be aware of the possible myocarditis complication because it can lead to a fatal arrhythmia. This particular case study involves a 65 year old man that initially presented with a virus that eventually suffered a fatal arrhythmia[1]. Lab tests and autopsies showed that this particular patient developed encephalitis and myocarditis secondary to West Nile virus infection[1].
Case 1 Presentation[1]
The patient was a 65 year old male of Scottish heritage. His clinical presentation showed:
His symptoms included:
His past medical history included:
- Diabetes
- Hypertension
- Former smoker
Upon arrival to the emergency department , the patients condition was relatively unremarkable. His electrocardiogram did in fact show a normal sinus rhythm at a rate of 83 beats/minute. The rest of this case is presented on a day by day basis.
Day 1
- Mild confusion and disorientation
- Blurred vision
- Fever of 103.4 degrees Fahrenheit
- The antibiotics being used at this point are:
- Ceftriaxone
- Vancomycin
- Antiviral acyclovir
Day 2
- Head CT showed chronic inflammatory changes.
- Lumbar puncture showed colorless cerebrospinal fluid
- The following tests were negative
- Bacterial and fungal
- Herpes simplex virus PCR of the cerebrospinal fluid
- Serum lyme antibodies
- Blood cultures
- Vancomycin was stopped. Acyclovir and ceftriaxone are continued.
- A transthoracic echocardiogram
- ↑ 1.0 1.1 1.2 1.3 Kushawaha A, Jadonath S, Mobarakai N (2009). "West nile virus myocarditis causing a fatal arrhythmia: a case report". Cases Journal. 2: 7147. doi:10.1186/1757-1626-2-7147. PMC 2740101. PMID 19829922. Retrieved 2012-03-27.