Jain Nitin, Fisk David, Sotir Mark, Kehl Karen S
Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
Transpl Int. 2007 Sep;20(9):800-3. doi: 10.1111/j.1432-2277.2007.00514.x. Epub 2007 Jul 13.
West Nile neuroinvasive disease (WNND) represents a small fraction of cases of West Nile Virus (WNV) infection. Organ transplantation is associated with increased risk of acquiring WNND. We report a patient with living-related renal transplantation who developed unusual manifestations of WNND. First, fatal status epilepticus unresponsive to pentobarbital ensued. Status epilepticus from WNV has been described very rarely in the medical literature. Second, this patient grew WNV on broncho-alveolar lavage samples. To our knowledge, this is the first case of culture positive West Nile pneumonia. Third, the finding in cerebrospinal fluid (CSF) of a negative West Nile immunoglobulin M (IgM) and a positive West Nile polymerase chain reaction is striking. It is consistent with a high-viral burden and impaired immune response. This finding raises questions about the appropriateness of relying on CSF IgM assays to rapidly diagnose WNV encephalitis in organ transplant patients, as has been recommended.
西尼罗河神经侵袭性疾病（WNND）仅占西尼罗河病毒（WNV）感染病例的一小部分。器官移植会增加感染WNND的风险。我们报告了一例亲属活体肾移植患者，该患者出现了WNND的异常表现。首先，患者发生了对戊巴比妥无反应的致命性癫痫持续状态。医学文献中很少描述由WNV引起的癫痫持续状态。其次，该患者支气管肺泡灌洗样本中培养出了WNV。据我们所知，这是首例培养阳性的西尼罗河肺炎病例。第三，脑脊液（CSF）检查发现西尼罗河免疫球蛋白M（IgM）阴性而西尼罗河聚合酶链反应阳性，这一结果令人瞩目。这与高病毒载量和免疫反应受损相一致。这一发现引发了关于按照推荐依靠脑脊液IgM检测来快速诊断器官移植患者WNV脑炎是否合适的疑问。
