A Rare Case of Neuroinvasive West Nile Virus in Florida Presenting As Guillain Barré Syndrome

Abstract

West Nile virus (WNV) is a leading cause of mosquito-borne illness in the continental United States. There are no vaccines to prevent or treat WNV, the mainstay of treatment is supportive care with rehydration, pain control, and possible antiemetic therapy. WNV is often asymptomatic but can rarely progress to a neuroinvasive disease, depicted by meningitis, encephalitis, and acute flaccid paralysis. This case report depicts a 64-year-old male who developed a rare neuroinvasive WNV in Florida. The patient was hospitalized for bilateral upper and lower extremity weakness, numbness, and tingling. CSF findings on admission were remarkable for albuminocytologic dissociation, suggesting that the patient was possibly suffering from isolated Guillain Barre Syndrome (GBS). The patient was treated with IVIG and plasmapheresis with no improvement in symptoms and later tested positive for WNV on day 22 of admission. This case highlights the variability in WNV presentation and CSF findings, highlighting the need for increased suspicion when patients present with findings consistent with GBS in the late summer months.

Keywords: guillain barre’s syndrome (gbs); mosquito vector; neuroinvasive west nile virus; west nile; zoonosis and public health.

Figure 1. Patient’s preseptal cellulitis on left cheek 12 days before admission

Figure 2. CT scan of the face with contrast indicates left periorbital preseptal cellulitis (red arrow) and left cheek cellulitis

Figure 3. MRI brain with contrast indicates scattered foci of abnormally increased signal within the white matter of the cerebral hemispheres (red arrows) and pons (black arrow), most likely representing small vessel microvascular atheromatous change.