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August 2004

West Nile Virus Encephalomyelitis in Transplant Recipients

Arch Neurol. 2004;61(8):1181. doi:10.1001/archneur.61.8.1181

This is the West Nile virus (WNV) encephalomyelitis season, and the ARCHIVES is calling attention to this serious form of infectious neurological disease by expediting the report of Kleinschmidt- DeMasters et al.1 The authors describe 11 transplant recipients (4 kidney, 2 stem cell, 2 liver, 1 lung, and 2 kidney/pancreas) who developed WNV encephalomyelitis with severe neurological consequences. All but 1 of these patients who were immunocompromised for reasons of their transplant had a prodrome typical of WNV encephalomyelitis reported in nonimmunosuppressed patients, which was followed by flaccid paralysis, meningoencephalitis, meningitis, and/or movement disorders. Magnetic resonance images of the brain were abnormal in 7 of 8 tested patients. Ten of 11 patients survived their acute infection; however, 4 have retained significant residual deficits. The authors conclude that these immunosuppressed transplant recipients show diagnostic, clinical, and laboratory findings similar to those found in nonimmunocompromised persons with WNV encephalomyelitis but that they initially or eventually develop neurological deficits at the severe end of the spectrum. This is an important message for physicians to hear and for which to be prepared.