School of Medicine and Health Sciences Poster Presentations

Title

Parkinsonian Symptoms with Fever

Poster Number

258

Document Type

Poster

Publication Date

3-2016

Abstract

Introduction: West Nile virus (WNV) is the most common arthropod borne virus and is the leading cause of domestically acquired disease in the United States.

Case Description: A 75-year-old man presented in August 2015 with sepsis and one day of confusion, fever of 104°F, a WBC of 19.80, and blood pressure of 204/91, in the setting of a recent admission for small bowel obstruction. On exam, he was only oriented to self with slurred speech, tongue and bilateral quadriceps fasciculations, cogwheel rigidity and tremor of bilateral upper arms, and dysmetria. He did not have skin changes, no meningeal signs, or visual problems. He was treated empirically for meningitis. Head CT, MRI, abdominal CT, CXR (Chest X-Ray) were negative. He remained febrile and hypertensive for four days, with worsening Parkinson’s features. Blood and urine cultures were negative and antibiotics were stopped. Neurology started a Sinemet trial. LP revealed mild pleocytosis and no detectable WNV. On day six, his WBC resolved, blood pressures were under control, and defervesced—only with supportive care. All of his Parkinson’s symptoms resolved. On day seven, serum WNV IgM was positively elevated > 5.00. One week later, he had seroconverted.

Discussion: This case report reminds us of the necessity to heighten public health awareness for WNV. It also portends the need for WNV surveillance in order to control disease spread.

Our priorities need to shift toward early disease identification and implementation of control measures.

Frequently, WNV cannot be detected in serum because the viremia is short lived and peaks before clinical symptoms are present. Only one case report has documented that WNV can present as Parkinsonian symptoms including hypomimia, bradykinesia and postural instability. Persistent fever without a known source should initiate a search for the cause, and merits a thorough review of the patient’s social history.

Treatment should be focused on supportive care while pending laboratory confirmation of WNV, and irrespective of imaging studies. Consistent with the literature, our patient did not have significant imaging findings. WNV can be a preventable disease if preventative measures are taken.

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Presented at: GW Research Days 2016

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Parkinsonian Symptoms with Fever

Introduction: West Nile virus (WNV) is the most common arthropod borne virus and is the leading cause of domestically acquired disease in the United States.

Case Description: A 75-year-old man presented in August 2015 with sepsis and one day of confusion, fever of 104°F, a WBC of 19.80, and blood pressure of 204/91, in the setting of a recent admission for small bowel obstruction. On exam, he was only oriented to self with slurred speech, tongue and bilateral quadriceps fasciculations, cogwheel rigidity and tremor of bilateral upper arms, and dysmetria. He did not have skin changes, no meningeal signs, or visual problems. He was treated empirically for meningitis. Head CT, MRI, abdominal CT, CXR (Chest X-Ray) were negative. He remained febrile and hypertensive for four days, with worsening Parkinson’s features. Blood and urine cultures were negative and antibiotics were stopped. Neurology started a Sinemet trial. LP revealed mild pleocytosis and no detectable WNV. On day six, his WBC resolved, blood pressures were under control, and defervesced—only with supportive care. All of his Parkinson’s symptoms resolved. On day seven, serum WNV IgM was positively elevated > 5.00. One week later, he had seroconverted.

Discussion: This case report reminds us of the necessity to heighten public health awareness for WNV. It also portends the need for WNV surveillance in order to control disease spread.

Our priorities need to shift toward early disease identification and implementation of control measures.

Frequently, WNV cannot be detected in serum because the viremia is short lived and peaks before clinical symptoms are present. Only one case report has documented that WNV can present as Parkinsonian symptoms including hypomimia, bradykinesia and postural instability. Persistent fever without a known source should initiate a search for the cause, and merits a thorough review of the patient’s social history.

Treatment should be focused on supportive care while pending laboratory confirmation of WNV, and irrespective of imaging studies. Consistent with the literature, our patient did not have significant imaging findings. WNV can be a preventable disease if preventative measures are taken.