West Nile Virus Presenting as Optic Perineuritis with Complete Recovery: Light at the End of the Tunnel
Year: 2024
Type: article
Study design: Case Report
Abstract: Objective The objective of this abstract is to highlight an uncommon presentation of West Nile virus infection with bilateral optic perineuritis. Background West Nile virus (WNV) is an arbovirus that has become endemic in the United States. The presentation ranges from mild febrile illness to severe nervous system involvement, including ocular manifestations. The most commonly described ocular manifestation of WNV is chorioretinitis. There is sparse literature on WNV-related optic neuritis. This report details a case of WNV neuroinvasive disease presenting with bilateral optic perineuritis and unilateral facial nerve palsy, who had a complete recovery. Design/Methods N/A. Results A 41-year-old woman with a history of renal transplant on tacrolimus, mycophenolate, and prednisone presented with a three-day history of fever, lethargy, headaches, double vision, and left eye pain. On exam, the patient had mild left peripheral facial nerve palsy. Visual acuity, fundoscopic exam, and extraocular movements were normal with no nystagmus. MRI Brain and Orbits revealed left greater than right thin linear enhancement of the optic nerve sheaths and perineural fat, consistent with optic perineuritis. Lumbar puncture had normal opening pressure, elevated CSF protein, and lymphocytic pleocytosis. CSF meningitis/encephalitis and paraneoplastic panels were negative. CSF arbovirus panel resulted positive for WNV IgM. The patient began to improve spontaneously on day eight of admission. A six-week follow-up MRI showed complete resolution of optic perineuritis. Conclusions WNV testing should be considered as part of the initial diagnostic work-up for optic perineuritis. It can present with a variety of neurological signs and can mimic other non-infectious etiologies. Full recovery can be seen with WNV-associated optic perineuritis and facial nerve palsy.
Source: Neurology
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4403207071