West Nile virus encephalitis causing fatal CNS toxicity after hematopoietic stem cell transplantation

TitleWest Nile virus encephalitis causing fatal CNS toxicity after hematopoietic stem cell transplantation
Publication TypeJournal Article
Year of Publication2004
AuthorsReddy P, Davenport R, Ratanatharathorn V, Reynolds C, Silver S, Ayash L, Ferrara JL, Uberti JP
JournalBone Marrow Transplantation
Pagination109 - 12
Date PublishedJan
Type of ArticleCase Reports
ISSN0268-3369 (Print) 0268-3369 (Linking)
Accession Number14566328
KeywordsAutopsy, Central Nervous System Diseases / *etiology, Fatal Outcome, Hematopoietic Stem Cell Transplantation / *adverse effects, Humans, Male, Mesencephalon / pathology / virology, Microscopy, Electron, Middle Aged, West Nile Fever / *complications

We describe here a patient who died of progressive CNS deterioration following allogeneic stem cell transplant with West Nile virus as the sole pathogen on the cerebrospinal fluid and brain tissue analysis. A 50-year-old male with Philadelphia chromosome-positive acute lymphocytic leukemia (ALL) underwent allogeneic PBSCT from his HLA identical sister. After engraftment, the patient developed fever with progressive and ultimately fatal neurological deterioration. Imaging studies of the brain including CT and MRI scans were remarkable for mild low attenuation lesions of the white matter. CSF analysis was negative for neoplastic cells, bacteria, AFB, CMV, HSV, fungal infections and leukemic relapse. However, serological analysis of both the serum and CSF was positive for West Nile virus-specific IgM antibodies. At autopsy, West Nile virus PCR and cultures were positive in the mid-brain tissue. Electron micrographs showed evidence of viral particles. Given the recent increase in the spread of West Nile virus infections and the increased susceptibility of BMT patients to infectious complications, West Nile virus encephalitis should be considered in patients undergoing transplantation.

Alternate JournalBone Marrow Transplant
Notify Library Reference ID1303

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