title: Fatal fulminant pan-meningo-polioencephalitis due to West Nile virus.
abstract: We report a case of fatal fulminant West Nile virus (WNV) meningoencephalitis in an 87-year-old white male gardener. The Pennsylvania patient presented with a 3-day history of flu-like symptoms. His hospital course was gravely precipitous with onset of coma, ventilator dependence, loss of cortical and brainstem functions within ten days of admission. Acute serum and cerebrospinal fluid samples revealed elevated levels of WNV IgM antibodies by ELISA as well as elevated CSF white blood cells, protein and glucose. A complete autopsy revealed a multifocal lymphocytic myocarditis and severe chronic tubulointerstitial nephritis. Viral culture and PCR analysis of post-mortem samples of the spleen, kidney and brain were positive for WNV. Histological sections from all regions of the brain and spinal cord demonstrated a severe, non-necrotizing, subacute, polio-meningoencephalitis. While both gray and white matter were inflamed, gray matter was much more severely involved. Many gray matter nuclei showed severe neuronal loss with residual dying neurons surrounded by activated microglia. Immunohistochemical stains revealed profuse infiltration of the meninges and cerebral parenchyma by CD8 T-lymphocytes and perivascular B-lymphocytes. Electron micrographs revealed diffuse intracellular and extracellular edema but no viral particles were identified. Immunohistochemical and immunofluorescent staining for WNV filled the cytoplasm of residual neurons. West Nile virus mediates a predominantly polioencephalitis secondary to direct infection of neurons.
authors.affiliation: Department of Pathology, University of Pittsburgh, PA 15213, USA.
authors.forename: Bennet I
authors.initials: BI
authors.lastname: Omalu
authors.forename: Abdulrazek A
authors.initials: AA
authors.lastname: Shakir
authors.forename: Guoji
authors.initials: G
authors.lastname: Wang
authors.forename: W Ian
authors.initials: WI
authors.lastname: Lipkin
authors.forename: Clayton A
authors.initials: CA
authors.lastname: Wiley
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015703:Antigens, CD / Q000378:metabolism; D015214:Antigens, Differentiation, Myelomonocytic / Q000378:metabolism; D017252:CD3 Complex / Q000378:metabolism; D016827:CD8 Antigens / Q000378:metabolism; D002490:Central Nervous System / Q000378:metabolism* / Q000473:pathology*; D003593:Cytoplasm / Q000378:metabolism; D004797:Enzyme-Linked Immunosorbent Assay; D017809:Fatal Outcome; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood / Q000134:cerebrospinal fluid; D007150:Immunohistochemistry; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008590:Meningoencephalitis / Q000097:blood / Q000134:cerebrospinal fluid / Q000401:mortality / Q000821:virology*; D018613:Microscopy, Confocal; D009422:Nervous System Diseases / Q000378:metabolism / Q000473:pathology; D011051:Poliomyelitis; D016133:Polymerase Chain Reaction / Q000379:methods; D013602:T-Lymphocytes, Cytotoxic / Q000378:metabolism; D014901:West Nile Fever / Q000401:mortality* / Q000503:physiopathology; D014902:West Nile virus / Q000276:immunology / Q000378:metabolism; D000097382:CD68 Molecule
chemical_list: D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; D017252:CD3 Complex; D016827:CD8 Antigens; D007075:Immunoglobulin M; C067980:CD68 antigen, human; D000097382:CD68 Molecule