Messacar Kevin, Cree-Green Melanie, Lovell Mark, Anderson Marsha S, Dominguez Samuel R
Department of Pediatrics, Section of Infectious Diseases, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado 80045, USA.
Department of Pediatrics, Section of Endocrinology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado 80045, USA.
IDCases. 2014;1(3):29-31. doi: 10.1016/j.idcr.2014.04.001.
This report describes a case of West Nile virus (WNV) meningoencephalitis in a child who presented with fever, headache, seizures, and altered mental status, as well as hyponatremia and bronzing of the skin. Findings that led to the diagnosis of WNV included plasma-cell pleocytosis of the cerebrospinal fluid (CSF) and linear chorioretinitis on ophthalmologic exam. The diagnosis was confirmed by a positive serum and CSF WNV IgM. The acute WNV infection triggered an adrenal crisis which uncovered a new diagnosis of underlying Addison's disease. This is the first case report of severe neuroinvasive WNV disease in a pediatric patient with primary adrenal insufficiency. Neuroinvasive WNV disease is uncommon in children, but may have a more severe presentation in those with certain underlying medical conditions.
本报告描述了一名儿童感染西尼罗河病毒（WNV）导致脑膜脑炎的病例，该患儿出现发热、头痛、癫痫发作、精神状态改变，以及低钠血症和皮肤青铜色改变。导致WNV诊断的发现包括脑脊液（CSF）浆细胞增多和眼科检查发现的线性脉络膜视网膜炎。血清和CSF中WNV IgM阳性证实了诊断。急性WNV感染引发了肾上腺危象，从而发现了潜在的艾迪生病这一新诊断。这是首例原发性肾上腺功能不全的儿科患者发生严重神经侵袭性WNV疾病的病例报告。神经侵袭性WNV疾病在儿童中并不常见，但在患有某些基础疾病的儿童中可能表现得更为严重。
