Fatal West Nile virus encephalitis in a renal transplant recipient.
West Nile virus (WNV), a mosquito-transmitted single-stranded RNA flavivirus, causes human disease of variable severity. We report clinical and pathologic findings of fatal encephalitis from the transmission of WNV from an organ donor to a kidney transplant recipient. The patient developed a febrile illness 18 days after transplantation, which progressed to encephalitis. Postmortem examination demonstrated extensive viral encephalopathic changes. Immunohistochemical studies highlighted WNV antigens within neurons, especially in the cerebellum and brainstem. Flavivirus virions were detected ultrastructurally within the cerebellum, and WNV was isolated from the brain and the brainstem. Thus, this case demonstrates the first death in the first solid organ transplant-associated transmission of WNV. Immunosuppression of the transplant recipient might have been responsible for the fulminant viral effects. The pathologic diagnosis helped guide subsequent epidemiologic and laboratory studies.
Cushing
Melissa M
MM
Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA.
Brat
Daniel J
DJ
Mosunjac
Mario I
MI
Hennigar
Randolph A
RA
Jernigan
Daniel B
DB
Lanciotti
Robert
R
Petersen
Lyle R
LR
Goldsmith
Cynthia
C
Rollin
Pierre E
PE
Shieh
Wun-Ju
WJ
Guarner
Jeannette
J
Zaki
Sherif R
SR
D000328:Adult; D001921:Brain / Q000473:pathology / Q000821:virology; D017809:Fatal Outcome; D006801:Humans; D016867:Immunocompromised Host; D007150:Immunohistochemistry; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D014019:Tissue Donors; D014901:West Nile Fever / Q000401:mortality / Q000473:pathology / Q000635:transmission*; D014902:West Nile virus / Q000276:immunology / Q000302:isolation & purification* / Q000648:ultrastructure