Concurrent West Nile virus infection in pneumococcal meningitis: clinical and MRI features.
We report the clinical and neuroimaging findings of an immunocompetent patient with concurrent pneumococcal and West Nile virus meningoencephalitis with relapsing clinical course despite a full course of antibiotic treatment. The patient developed acute oculomotor nerve palsy with pupillary involvement and bilateral hearing loss, and delayed right leg monoparesis. We speculate that coexisting bacterial and viral neuroinvasive infections contributed to the unusual clinical and imaging manifestations, and that overwhelming laboratory and clinical features of bacterial meningitis masked the typical features of CNS viral infection. Therefore, atypical presentations of bacterial meningitis should raise a high index of suspicion for coexisting infections, even in immunocompetent patients, and evolving neuroimaging findings may be helpful in substantiating clinical suspicion and guiding further management.
Hattiesburg Clinic, PA - Neurology, Hattiesburg, MS.
Gabriella
G
Szatmary
Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson, MS.
A Arturo
AA
Leis
D001921:Brain / Q000473:pathology*; D003937:Diagnosis, Differential; D006801:Humans; D000069544:Infectious Encephalitis; D008279:Magnetic Resonance Imaging; D008586:Meningitis, Pneumococcal / Q000150:complications* / Q000473:pathology*; D014901:West Nile Fever / Q000150:complications* / Q000473:pathology*
Meningoencephalitis; West Nile; diplopia; monoparesis; pneumococcus