Department of Medicine, Ibri Hospital, Ibri, Oman.
Department of Renal Medicine, Royal Hospital, Muscat, Oman.
Saudi J Kidney Dis Transpl. 2021 Mar-Apr;32(2):532-542. doi: 10.4103/1319-2442.335467.
West Nile virus (WNV) infections are a mosquito-borne virus of the Flaviviridae family. The clinical feature of the virus varies between individuals from being asymptomatic in most of the cases to severe central nervous system disease manifested as meningitis, encephalitis, and paralysis. Diabetic nephropathy patient with microvascular and macrovascular complications, who received a kidney transplant a year ago on immunosuppressive therapy, presented with a three-day history of upper respiratory tract infection and fever. He lived in an endemic area of brucella infection. He underwent a thorough and full evaluation with various laboratory and radiological evaluations. The patient was started empirically on ceftriaxone and acyclovir for a presumptive diagnosis of herpes encephalitis and covering also Listeria with ampicillin. The patient did not improve with the initial management, so a T2-weighted magnetic resonance imaging of the brain executed that showed nonspecific hyper-intensity in the left frontal area suggestive of microangiopathic changes. WNV-neutralizing antibodies were positive with a high titer >1:640, whereas WNV RNA was not detected in the plasma sample. In the serum sample, WNV IgM and IgG were both positive. WNV IgM antibodies were detected with 6.55 and 5.97 antibody index and were done by a semiquantitative ELISA. Furthermore, WNV-neutralizing antibodies were positive as well as with a titer of 1:80. As there is no specific antiviral treatment available, the patient management was supportive; reduction in immunosuppressive agents and the use of IV IgG. This is the first reported case of one-year post renal transplant who developed WNV encephalitis and neuropathy with significant response to immunoglobulin after 18 days of infections.
西尼罗河病毒（WNV）感染是黄病毒科的一种蚊媒病毒。该病毒在个体中的临床特征差异很大，大多数情况下无症状，严重时可表现为中枢神经系统疾病，包括脑膜炎、脑炎和瘫痪。一名患有微血管和大血管并发症的糖尿病肾病患者，一年前接受了肾移植，并接受免疫抑制治疗，因上呼吸道感染和发热出现三天病史。他生活在布鲁氏菌感染的流行地区。他接受了彻底和全面的评估，包括各种实验室和影像学评估。根据疱疹性脑炎的推测诊断，患者开始经验性使用头孢曲松和阿昔洛韦治疗，同时还使用氨苄西林覆盖李斯特菌。初始治疗后患者病情未改善，因此进行了脑 T2 加权磁共振成像，结果显示左侧额区存在非特异性高信号，提示微血管病变改变。WNV 中和抗体呈阳性，滴度>1:640，而血浆样本中未检测到 WNV RNA。血清样本中，WNV IgM 和 IgG 均呈阳性。WNV IgM 抗体的抗体指数分别为 6.55 和 5.97，通过半定量 ELISA 检测。此外，WNV 中和抗体也呈阳性，滴度为 1:80。由于目前尚无特效抗病毒治疗方法，因此对患者进行了支持性治疗，包括减少免疫抑制剂和使用静脉注射免疫球蛋白。这是首例报道的肾移植后一年发生 WNV 脑炎和神经病的病例，感染 18 天后，免疫球蛋白治疗效果显著。
