West Nile virus (WNV) is a flavivirus endemic in the United States. WNV infection can present with a variety of non-neurologic and neurologic symptoms. Patients who present with WNV neuroinvasive dise..
West Nile virus (WNV) is a flavivirus endemic in the United States. WNV infection can present with a variety of non-neurologic and neurologic symptoms. Patients who present with WNV neuroinvasive disease have significant morbidity and mortality, with about 10% of cases resulting in death. There is currently no evidence-based treatment for WNV infection. Management is typically with supportive care. Some limited data shows corticosteroids as a possible treatment for neuroinvasive disease. This case report discusses a 55-year-old female patient who presented with altered mental status. She was found to be septic overnight and was found to be in status epilepticus on EEG. The patient was intubated and sedated, started on multiple antiepileptic medications. Sepsis workup was initiated, and empiric antibiotics were started. A lumbar puncture was performed, showing findings consistent with a viral encephalitis. Continuous EEG showed frequent seizures and other epileptiform discharges. Due to no significant improvement, the patient was started on high dose intravenous corticosteroids. The infectious workup eventually revealed that the patient had West Nile virus infection. With the antiepileptic medications and high dose steroids, the patient had a rapid recovery. She was soon able to be extubated and discharged to a rehab facility. There are some conflicting data, with case reports and small retrospective studies, about the efficacy of corticosteroids in the management of WNV neuroinvasive disease. A possible mechanism is corticosteroids having anti-inflammatory properties that can improve the perivascular inflammation associated with WNV neuroinvasive disease. High dose corticosteroids were found to be very effective for the management of WNV neuroinvasive disease in this case.