title: Fatal West Nile virus encephalitis in a renal transplant recipient.
abstract: 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.
authors.affiliation: Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Cushing
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Brat
authors.forename: Mario I
authors.initials: MI
authors.lastname: Mosunjac
authors.forename: Randolph A
authors.initials: RA
authors.lastname: Hennigar
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Jernigan
authors.forename: Robert
authors.initials: R
authors.lastname: Lanciotti
authors.forename: Lyle R
authors.initials: LR
authors.lastname: Petersen
authors.forename: Cynthia
authors.initials: C
authors.lastname: Goldsmith
authors.forename: Pierre E
authors.initials: PE
authors.lastname: Rollin
authors.forename: Wun-Ju
authors.initials: WJ
authors.lastname: Shieh
authors.forename: Jeannette
authors.initials: J
authors.lastname: Guarner
authors.forename: Sherif R
authors.initials: SR
authors.lastname: Zaki
mesh_terms: 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