West Nile virus (
WNV) infections are a mosquito-borne virus of the Flaviviridae family. The clinical feature of the virus varies between individuals from being asymptomatic in most of the cases to severe
central nervous system disease manifested as
meningitis,
encephalitis, and
paralysis.
Diabetic nephropathy patient with microvascular and macrovascular complications, who received a kidney transplant a year ago on immunosuppressive therapy, presented with a three-day history of
upper respiratory tract infection and
fever. He lived in an endemic area of
brucella infection. He underwent a thorough and full evaluation with various laboratory and radiological evaluations. The patient was started empirically on
ceftriaxone and
acyclovir for a presumptive diagnosis of
herpes encephalitis and covering also Listeria with
ampicillin. The patient did not improve with the initial management, so a T2-weighted magnetic resonance imaging of the brain executed that showed nonspecific hyper-intensity in the left frontal area suggestive of microangiopathic changes. WNV-
neutralizing antibodies were positive with a high titer >1:640, whereas WNV
RNA was not detected in the plasma sample. In the serum sample, WNV
IgM and
IgG were both positive. WNV
IgM antibodies were detected with 6.55 and 5.97 antibody index and were done by a semiquantitative ELISA. Furthermore, WNV-
neutralizing antibodies were positive as well as with a titer of 1:80. As there is no specific
antiviral treatment available, the patient management was supportive; reduction in
immunosuppressive agents and the use of IV
IgG. This is the first reported case of one-year post renal transplant who developed WNV
encephalitis and neuropathy with significant response to
immunoglobulin after 18 days of
infections.