West Nile encephalitis, status epilepticus and West Nile pneumonia in a renal transplant patient

  1. Nitin Jain1,
  2. David Fisk2,
  3. Mark Sotir3,
  4. Karen S. Kehl4

Article first published online: 13 JUL 2007

DOI: 10.1111/j.1432-2277.2007.00514.x

Issue

Transplant International

Transplant International

Volume 20, Issue 9, pages 800–803, September 2007

Additional Information

How to Cite

Jain, N., Fisk, D., Sotir, M. and Kehl, K. S. (2007), West Nile encephalitis, status epilepticus and West Nile pneumonia in a renal transplant patient. Transplant International, 20: 800–803. doi: 10.1111/j.1432-2277.2007.00514.x

Author Information

  1. 1

     Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA

  2. 2

     Division of Infectious Diseases, Sansum Clinic, Santa Barbara, CA, USA

  3. 3

     Wisconsin Division of Public Health, Bureau of Communicable Diseases, Madison, WI, USA

  4. 4

     Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA

*Dr. David Fisk, Division of Infectious Diseases, Sansum Clinic, 317 W. Pueblo Street, Santa Barbara, CA 93105, USA. Tel.: +1 805 898 3561; fax: +1 805 898 3091; e-mail: dfisk@sansumclinic.org

Publication History

  1. Issue published online: 13 JUL 2007
  2. Article first published online: 13 JUL 2007
  3. Received: 23 March 2007 Revision requested: 18 April 2007 Accepted: 1 June 2007

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Keywords:

  • diagnosis;
  • encephalitis;
  • pneumonia;
  • renal transplant;
  • status epilepticus;
  • West Nile virus

Summary

West Nile neuroinvasive disease (WNND) represents a small fraction of cases of West Nile Virus (WNV) infection. Organ transplantation is associated with increased risk of acquiring WNND. We report a patient with living-related renal transplantation who developed unusual manifestations of WNND. First, fatal status epilepticus unresponsive to pentobarbital ensued. Status epilepticus from WNV has been described very rarely in the medical literature. Second, this patient grew WNV on broncho-alveolar lavage samples. To our knowledge, this is the first case of culture positive West Nile pneumonia. Third, the finding in cerebrospinal fluid (CSF) of a negative West Nile immunoglobulin M (IgM) and a positive West Nile polymerase chain reaction is striking. It is consistent with a high-viral burden and impaired immune response. This finding raises questions about the appropriateness of relying on CSF IgM assays to rapidly diagnose WNV encephalitis in organ transplant patients, as has been recommended.

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