A case of West Nile virus encephalitis accompanied by diabetic ketoacidosis and rhabdomyolysis
Introduction: We present here a case of West Nile Virus (WNV) encephalitis that initially presented with diabetic ketoacidosis and rhabdomyolysis. Case presentation: A 35-year-old male with no past medical history presented to the emergency department complaining of polydipsia, generalized weakness,...
Main Authors: | , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Elsevier
2019-01-01
|
Series: | IDCases |
Online Access: | http://www.sciencedirect.com/science/article/pii/S2214250919300034 |
id |
doaj-93e0b5e88c9e402785c20cbe19939911 |
---|---|
record_format |
Article |
spelling |
doaj-93e0b5e88c9e402785c20cbe199399112021-07-02T05:45:24ZengElsevierIDCases2214-25092019-01-0115A case of West Nile virus encephalitis accompanied by diabetic ketoacidosis and rhabdomyolysisZachary Burden0Madeline Fasen1Benjamin L. Judkins2Carmen Isache3Department of Medicine, University of Florida College of Medicine-Jacksonville, Florida, United States; Corresponding author.Department of Medicine, University of Florida College of Medicine-Jacksonville, Florida, United StatesUniversity of Florida College of Medicine-Gainesville, Florida, United StatesDepartment of Medicine, University of Florida College of Medicine-Jacksonville, Florida, United StatesIntroduction: We present here a case of West Nile Virus (WNV) encephalitis that initially presented with diabetic ketoacidosis and rhabdomyolysis. Case presentation: A 35-year-old male with no past medical history presented to the emergency department complaining of polydipsia, generalized weakness, lightheadedness, and visual disturbances of one week duration. He was found to be in diabetic ketoacidosis. His hemoglobin A1c was 11%. The patient was appropriately treated for diabetic ketoacidosis and it resolved on hospital day 1. On hospital day 2, the patient developed a fever of 101.6 °F and his mental status became severely altered. He developed auditory and visual hallucinations. IgM and IgG antibodies to West Nile Virus were positive in the cerebral spinal fluid (CSF). The patient's creatine kinase level rose to 118,400 U/L during his hospitalization and eventually returned to baseline. The patient made a full recovery with no residual neurologic deficits after an 11 day hospital course. Discussion: In this patient, neuroinvasive WNV was confirmed with positive CSF IgM. The patient’s newly diagnosed diabetes likely contributed to his susceptibility to neuroinvasive disease. Furthermore, WNV encephalitis in a background of DKA has not been previously described in the literature and this case demonstrates WNV neuroinvasive disease should be in the differential diagnosis for patients presenting with unexplained neurological symptoms. Conclusion: Diagnosis of neuroinvasive WNV is imperative to stop unnecessary therapies, limit further diagnostic evaluation, help predict patient outcomes, direct public health prevention measures, and further provide investigations into the clinical conditions that define the spectrum of WNV disease. Keywords: DKA, Diabetic ketoacidosis, West Nile Virus, WNV, Rhabdomyolysis, Neuroinvasivehttp://www.sciencedirect.com/science/article/pii/S2214250919300034 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Zachary Burden Madeline Fasen Benjamin L. Judkins Carmen Isache |
spellingShingle |
Zachary Burden Madeline Fasen Benjamin L. Judkins Carmen Isache A case of West Nile virus encephalitis accompanied by diabetic ketoacidosis and rhabdomyolysis IDCases |
author_facet |
Zachary Burden Madeline Fasen Benjamin L. Judkins Carmen Isache |
author_sort |
Zachary Burden |
title |
A case of West Nile virus encephalitis accompanied by diabetic ketoacidosis and rhabdomyolysis |
title_short |
A case of West Nile virus encephalitis accompanied by diabetic ketoacidosis and rhabdomyolysis |
title_full |
A case of West Nile virus encephalitis accompanied by diabetic ketoacidosis and rhabdomyolysis |
title_fullStr |
A case of West Nile virus encephalitis accompanied by diabetic ketoacidosis and rhabdomyolysis |
title_full_unstemmed |
A case of West Nile virus encephalitis accompanied by diabetic ketoacidosis and rhabdomyolysis |
title_sort |
case of west nile virus encephalitis accompanied by diabetic ketoacidosis and rhabdomyolysis |
publisher |
Elsevier |
series |
IDCases |
issn |
2214-2509 |
publishDate |
2019-01-01 |
description |
Introduction: We present here a case of West Nile Virus (WNV) encephalitis that initially presented with diabetic ketoacidosis and rhabdomyolysis. Case presentation: A 35-year-old male with no past medical history presented to the emergency department complaining of polydipsia, generalized weakness, lightheadedness, and visual disturbances of one week duration. He was found to be in diabetic ketoacidosis. His hemoglobin A1c was 11%. The patient was appropriately treated for diabetic ketoacidosis and it resolved on hospital day 1. On hospital day 2, the patient developed a fever of 101.6 °F and his mental status became severely altered. He developed auditory and visual hallucinations. IgM and IgG antibodies to West Nile Virus were positive in the cerebral spinal fluid (CSF). The patient's creatine kinase level rose to 118,400 U/L during his hospitalization and eventually returned to baseline. The patient made a full recovery with no residual neurologic deficits after an 11 day hospital course. Discussion: In this patient, neuroinvasive WNV was confirmed with positive CSF IgM. The patient’s newly diagnosed diabetes likely contributed to his susceptibility to neuroinvasive disease. Furthermore, WNV encephalitis in a background of DKA has not been previously described in the literature and this case demonstrates WNV neuroinvasive disease should be in the differential diagnosis for patients presenting with unexplained neurological symptoms. Conclusion: Diagnosis of neuroinvasive WNV is imperative to stop unnecessary therapies, limit further diagnostic evaluation, help predict patient outcomes, direct public health prevention measures, and further provide investigations into the clinical conditions that define the spectrum of WNV disease. Keywords: DKA, Diabetic ketoacidosis, West Nile Virus, WNV, Rhabdomyolysis, Neuroinvasive |
url |
http://www.sciencedirect.com/science/article/pii/S2214250919300034 |
work_keys_str_mv |
AT zacharyburden acaseofwestnilevirusencephalitisaccompaniedbydiabeticketoacidosisandrhabdomyolysis AT madelinefasen acaseofwestnilevirusencephalitisaccompaniedbydiabeticketoacidosisandrhabdomyolysis AT benjaminljudkins acaseofwestnilevirusencephalitisaccompaniedbydiabeticketoacidosisandrhabdomyolysis AT carmenisache acaseofwestnilevirusencephalitisaccompaniedbydiabeticketoacidosisandrhabdomyolysis AT zacharyburden caseofwestnilevirusencephalitisaccompaniedbydiabeticketoacidosisandrhabdomyolysis AT madelinefasen caseofwestnilevirusencephalitisaccompaniedbydiabeticketoacidosisandrhabdomyolysis AT benjaminljudkins caseofwestnilevirusencephalitisaccompaniedbydiabeticketoacidosisandrhabdomyolysis AT carmenisache caseofwestnilevirusencephalitisaccompaniedbydiabeticketoacidosisandrhabdomyolysis |
_version_ |
1721338297316278272 |