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Case Reports
. 2025 Jun 24:13:2050313X241305165.
doi: 10.1177/2050313X241305165. eCollection 2025.

West Nile neuroinvasive disease with poliomyelitis syndrome: A grave phenomenon

Benjamin Easow  1 , Muhammad Qureshi  1 , Saikiran Mandyam  1 , Stephen Lavanier  1 , Sanjida Jahan  1 , Taylor Delie  1 , Kateryna Feldman  1 , Fnu Anshul  1
Affiliations
Case Reports

West Nile neuroinvasive disease with poliomyelitis syndrome: A grave phenomenon

Benjamin Easow et al. SAGE Open Med Case Rep. .

Abstract

West Nile virus infection poses a significant threat, especially during the warmer months when mosquitoes are abundant. Clinicians must remain vigilant for neuroinvasive illness in patients presenting with febrile symptoms and malaise following mosquito exposure. While magnetic resonance imaging and cerebrospinal fluid analysis aid in differential diagnosis, detecting West Nile immunoglobulin M in serum is crucial for definitive diagnosis. Treatment primarily involves supportive care due to the absence of established regimens, though promising outcomes have been reported with plasma exchange and intravenous immunoglobulin. We present the case of an 83-year-old resident of Alabama, an avid gardener living near a pond, who initially exhibited symptoms of productive cough, diarrhea, fever, and generalized malaise. However, within 48 h, he developed hypoxemia, functional quadriplegia, and bulbar palsy necessitating intubation. Diagnostic evaluations, including magnetic resonance imaging and positive West Nile virus immunoglobulin M in serum, confirmed West Nile virus-associated poliomyelitis viral syndrome, prompting intravenous immunoglobulin therapy. This case highlights the importance of promptly identifying and managing West Nile virus infection, especially in regions susceptible to mosquito-borne diseases, and being vigilant of the disease in non-endemic regions. The case also begs the question of the timing and efficacy of intravenous immunoglobulin and plasma exchange in West Nile virus infection and the fact that more data should be collected on these therapies.

Keywords: West Nile encephalitis; West Nile neuroinvasive disease with poliomyelitis syndrome; West Nile virus; caudal nerve root enhancement; flavivirus.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
MRI lumbar spine with and without contrast prior to IVIG: lumbar spine sagittal view showing caudal nerve root enhancement. IVIG: intravenous immunoglobulin.
Figure 2.
Figure 2.
MRI lumbar spine with and without contrast prior to IVIG: T1 axial, L1-L2. IVIG: intravenous immunoglobulin.
Figure 3.
Figure 3.
MRI lumbar spine with and without contrast prior to IVIG: T1 axial, L2-L3. IVIG: intravenous immunoglobulin.
Figure 4.
Figure 4.
MRI lumbar spine with and without contrast prior to IVIG: T1 axial, L3-L4. IVIG: intravenous immunoglobulin.
Figure 5.
Figure 5.
MRI lumbar spine with and without contrast prior to IVIG: T1 axial, L4-L5. IVIG: intravenous immunoglobulin.
Figure 6.
Figure 6.
MRI lumbar spine with and without contrast prior to IVIG: T1 axial, L5-S1. IVIG: intravenous immunoglobulin.
Figure 7.
Figure 7.
MRI lumbar spine with and without contrast post-IVIG: lumbar spine sagittal view with no significant interval change with stable subtle enhancement of the nerve roots of the cauda equina. IVIG: intravenous immunoglobulin.
Figure 8.
Figure 8.
MRI lumbar spine with and without contrast post-IVIG: T1 axial, L1-L2. IVIG: intravenous immunoglobulin.
Figure 9.
Figure 9.
MRI lumbar spine with and without contrast post-IVIG: T1 axial, L2-L3. IVIG: intravenous immunoglobulin.
Figure 10.
Figure 10.
MRI lumbar spine with and without contrast post-IVIG: T1 axial, L3-L4. IVIG: intravenous immunoglobulin.
Figure 11.
Figure 11.
MRI lumbar spine with and without contrast post-IVIG: T1 axial, L4-L5. IVIG: intravenous immunoglobulin.
Figure 12.
Figure 12.
West Nile virus human disease cases by year of illness onset, 1999–2022.
Figure 13.
Figure 13.
West Nile virus human disease cases by age and sex, 1999–2022.
Figure 14.
Figure 14.
West Nile virus human disease cases reported by month of illness onset, 1999–2022, all disease cases.
Figure 15.
Figure 15.
West Nile virus human disease cases reported by month of illness onset, 1999–2022, neuroinvasive disease cases.
Figure 16.
Figure 16.
West Nile virus human neuroinvasive disease average annual incidence per 100,000 population by county of residence, 1999–2022.
Figure 17.
Figure 17.
West Nile Virus disease recognition by state.
See this image and copyright information in PMC

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