Abstract Details

Title Neurologic Features and Brain Imaging Findings of Immunosuppressed Individuals With West Nile Virus Meningoencephalitis: A Case Series of 4 Patients

Topic Infectious Disease

Presentation(s) S28 - Infectious Disease: Chronic Meningitis and the Immunosuppressed (2:48 PM-3:00 PM)

Poster/Presentation
Number 010

Background The number of immunocompromised individuals continues to rise in the United States, in part given the increasing number of solid organ and stem cell recipients. Despite the increased risk of West Nile virus encephalitis (WNVE) in these individuals, data on radiographic and other clinical features and outcomes is limited.

Objective NA

Design/Methods We retrospectively reviewed clinical, laboratory, neuroimaging findings and outcomes of four immunocompromised patients with WNVE, that were treated at Mayo Clinic Arizona between June and September 2019.

Results The mean(SD) age of our patients was 69.5(4.8) years and 75% (3/4) were females. Two of the patients were kidney transplant recipients and the other two had an underlying hematological malignancy. The most common presenting features were malaise (100%; 4/4), fever (50%; 2/4) and tremors (50%; 2/4). Cerebrospinal fluid analysis (CSF) showed a mean(SD) cell count of 204(112) cells /mcl with neutrophilic predominance in 50% and lymphocytic predominance in the remaining patients. CSF testing was positive for WNV PCR for all patients with an average time to detection of 4 days from presentation. Brain MRI findings included small foci of diffusion restriction or T2 hyperintensity in bilateral thalami, pons, and/or cerebellum with progressive worsening on repeat evaluations. All patients exhibited profound worsening in respiratory status and encephalopathy within days of admission requiring mechanical ventilation in 75% (3/4). All patients received treatment (initiated 5-9 days post symptom onset) with intravenous immunoglobulins (IVIG; 2/4) or IVIG combined with interferon (2/4). No significant clinical improvement was seen in any of the cases and all 4 patients ultimately died after it was decided to withdraw care.

Conclusions WNVE is associated with significant morbidity and mortality in immunosuppressed patients. Improved understanding of the spectrum of brain imaging findings and their respective roles in the early identification of affected patients is warranted.

Authors/Disclosures
Amir A. Mbonde, MD (Mayo Clinic Arizona) PRESENTER	Dr. Mbonde has nothing to disclose.
David Gritsch, MD, PhD (Mayo Clinic)	Dr. Gritsch has nothing to disclose.
Angela Parsons, DO (OhioHealth Physicians Group)	Dr. Parsons has nothing to disclose.
	No disclosure on file
Marie F. Grill, MD (Mayo Clinic)	Dr. Grill has nothing to disclose.

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