Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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July 7, 2014
West Nile Virus Myelitis (Serum IgM +)
- Background: West Nile Virus is a flavivirus transmitted by mosquito bite, with increasing prevalence in North America.
- Relevant Clinical Information: Approximately 80% of infected individuals are asymptomatic; 20% present with a low-grade fever, fatigue, arthralgias, and GI symptoms; and fewer than 1% with meningoencephalitis.
- Key Diagnostic Features: Encephalitis classically presents with bilateral basal ganglia and thalamic T2 hyperintensity. Anterior myelitis, as seen in this case, is a less common manifestation.
- DDx: Other causes of infectious myelitis (HSV, CMV, mycoplasma, polio), idiopathic transverse myelitis, vascular and demyelinating disease, Guillain-Barré, and CIDP.
- Rx: Supportive therapy ± steroids
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