Alker Ashely
Department of Medicine, George Washington University, Washington, DC, USA.
BMJ Case Rep. 2015 May 2;2015:bcr2014206480. doi: 10.1136/bcr-2014-206480.
A 43-year-old woman presented to George Washington emergency department with 48 h of new-onset inguinal pain. Physical examination revealed a diffuse maculopapular rash involving the palms and soles, as well as inguinal lymphadenopathy. The patient denied recent travel outside of Washington, DC, and had no known sick contacts. She was admitted to the hospital for observation. Within 24 h of admission she developed left lower extremity flaccid paralysis, with loss of left patellar and Achilles reflexes. cerebrospinal fluid was positive for West Nile virus IgG and IgM antibodies, so methylprednisone 125 mg intravenously two times per day was started. On day 7, the patient recovered reflexes and continued to regain strength in the left lower extremity. She was discharged on day 9 on prednisone taper, with outpatient follow-up.
一名43岁女性因腹股沟疼痛新发48小时就诊于乔治·华盛顿大学急诊室。体格检查发现手掌和足底出现弥漫性斑丘疹，以及腹股沟淋巴结病。患者否认近期出过华盛顿特区，也没有已知的患病接触史。她被收入院观察。入院后24小时内，她出现左下肢弛缓性麻痹，左侧髌反射和跟腱反射消失。脑脊液检测西尼罗河病毒IgG和IgM抗体呈阳性，因此开始静脉注射甲泼尼龙125毫克，每日两次。第7天，患者恢复了反射，左下肢力量也持续恢复。她在第9天出院，逐渐减量服用泼尼松，并进行门诊随访。
