Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2014;1(3):29-31.
doi: 10.1016/j.idcr.2014.04.001.

Severe Neuroinvasive West Nile Virus Infection in a Child with Undiagnosed Addison's Disease

Kevin Messacar  1 , Melanie Cree-Green  2 , Mark Lovell  3 , Marsha S Anderson  1 , Samuel R Dominguez  1
Affiliations
Case Reports

Severe Neuroinvasive West Nile Virus Infection in a Child with Undiagnosed Addison's Disease

Kevin Messacar et al. IDCases. 2014.

Abstract

This report describes a case of West Nile virus (WNV) meningoencephalitis in a child who presented with fever, headache, seizures, and altered mental status, as well as hyponatremia and bronzing of the skin. Findings that led to the diagnosis of WNV included plasma-cell pleocytosis of the cerebrospinal fluid (CSF) and linear chorioretinitis on ophthalmologic exam. The diagnosis was confirmed by a positive serum and CSF WNV IgM. The acute WNV infection triggered an adrenal crisis which uncovered a new diagnosis of underlying Addison's disease. This is the first case report of severe neuroinvasive WNV disease in a pediatric patient with primary adrenal insufficiency. Neuroinvasive WNV disease is uncommon in children, but may have a more severe presentation in those with certain underlying medical conditions.

Keywords: Addison’s disease; West Nile virus; adrenal insufficiency; chorioretinitis; encephalitis; plasma cell pleocytosis of cerebrospinal fluid.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Cerebrospinal fluid cytospin with plasma cell predominant pleocytosis.
Fig. 2
Fig. 2
Linear and scattered round chorioretinal lesions on ophthalmologic exam.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

  • Autoantibodies neutralizing type I IFNs underlie West Nile virus encephalitis in ∼40% of patients.
    Gervais A, Rovida F, Avanzini MA, Croce S, Marchal A, Lin SC, Ferrari A, Thorball CW, Constant O, Le Voyer T, Philippot Q, Rosain J, Angelini M, Pérez Lorenzo M, Bizien L, Achille C, Trespidi F, Burdino E, Cassaniti I, Lilleri D, Fornara C, Sammartino JC, Cereda D, Marrocu C, Piralla A, Valsecchi C, Ricagno S, Cogo P, Neth O, Marín-Cruz I, Pacenti M, Sinigaglia A, Trevisan M, Volpe A, Marzollo A, Conti F, Lazzarotto T, Pession A, Viale P, Fellay J, Ghirardello S, Aubart M, Ghisetti V, Aiuti A, Jouanguy E, Bastard P, Percivalle E, Baldanti F, Puel A, MacDonald MR, Rice CM, Rossini G, Murray KO, Simonin Y, Nagy A, Barzon L, Abel L, Diamond MS, Cobat A, Zhang SY, Casanova JL, Borghesi A. Gervais A, et al. J Exp Med. 2023 Sep 4;220(9):e20230661. doi: 10.1084/jem.20230661. Epub 2023 Jun 22. J Exp Med. 2023. PMID: 37347462 Free PMC article.
  • Evaluation for Arboviral Infection Among Children Hospitalized in Colorado With Aseptic Meningitis and Encephalitis.
    Gould CV, Messacar K, Dominguez SR, Panella A, Tobolowsky F, Fischer M. Gould CV, et al. Pediatr Infect Dis J. 2020 Nov;39(11):e382-e384. doi: 10.1097/INF.0000000000002856. Pediatr Infect Dis J. 2020. PMID: 32773665 Free PMC article.

References

    1. Petersen L.R., Carson P.J., Biggerstaff B.J., Custer B., Borchardt S.M., Busch M.P. Estimated cumulative incidence of West Nile virus infection in US adults, 1999–2010. Epidemiol Infect. 2012:1–5. - PMC - PubMed
    1. Davis L.E., DeBiasi R., Goade D.E., Haaland K.Y., Harrington J.A., Harner J.B. West Nile virus neuroinvasive disease. Ann Neurol. 2006;60:286–300. - PubMed
    1. Lindsey N.P., Hayes E.B., Staples J.E., Fischer M. West Nile virus disease in children, United States, 1999–2007. Pediatrics. 2009;123:e1084–e1089. - PubMed
    1. Centers for Disease Control and Prevention: National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Vector-Borne Diseases (DVBD) 2012. 2012 West Nile virus human infections in the United States. Available from: http://www.cdc.gov/ncidod/dvbid/westnile/surv&controlCaseCount12_detaile... [accessed 22.5.13]
    1. Carson P.J., Steidler T., Patron R., Tate J.M., Tight R., Smego R.A., Jr. Plasma cell pleocytosis in cerebrospinal fluid in patients with West Nile virus encephalitis. Clin Infect Dis. 2003;37:e12–e15. - PubMed

Publication types

LinkOut - more resources