West Nile virus encephalitis: Atypical clinical presentation

Abstract

Introduction: West Nile virus (WNV) infection is mostly asymptomatic, whereas a severe neuroinvasive form, which may manifest as dyspnea, tachypnea, and acute respiratory failure, develops in less than 1% of cases. Aim: To highlight the diagnostic and prognostic significance of dyspnea and tremor in West Nile virus infection. Case Report: An emergency medical services (EMS) team was dispatched to an 81-year-old female patient due to the sudden onset of tremors and choking. The initial examination revealed fever (38.9°C), tachycardia (137 bpm), hypertension (155/95 mmHg), stable oxygen saturation (SpO 2 97%), and a pronounced whole-body tremor with slurred speech. The patient had a history of chronic cardiac disease. Following antipyretic administration, laboratory testing was advised. Three days later, due to general deterioration, the EMS team found the patient confused, afebrile, presenting with severe tremors, hypotension (105/45 mmHg), and rapid, heart rate (127 bpm). She was transported to the Clinic for Infectious Diseases of the Clinical Center of Vojvodina, where WNV encephalitis was confirmed. Due to progressive respiratory failure, the patient was sedated, intubated, and placed on mechanical ventilation on the seventh day of symptom onset. Conclusion: Although dyspnea is primarily a symptom of cardiac or pulmonary diseases, viral infections of the central nervous system can also manifest with this clinical feature. In these patients, dyspnea serves as a negative prognostic factor.