Acute Neurological Illness in a Kidney Transplant Recipient Following Infection With Enterovirus-D68: An Emerging...

Area of Science:

• Infectious Diseases
• Neurology
• Transplantation Immunology

Background:

• Enterovirus-D68 (EV-D68) is a respiratory virus that can cause severe neurological illness.
• Kidney transplant recipients are immunocompromised, potentially increasing their susceptibility to opportunistic infections and complications.
• Acute flaccid paralysis (AFP) is a rare but serious neurological condition that can be caused by various infectious agents.

Observation:

• A 45-year-old adult living-donor kidney transplant recipient developed an upper respiratory infection.
• Within hours of respiratory symptoms, the patient experienced rapidly progressive bulbar weakness, cranial nerve dysfunction, and asymmetric flaccid limb paralysis.
• Nasopharyngeal swabs confirmed enterovirus/rhinovirus, later identified as EV-D68. Brain MRI revealed characteristic gray matter and anterior horn cell changes.

Findings:

• The clinical presentation and neuroimaging findings were highly suggestive of EV-D68-associated acute disseminated encephalomyelitis (ADEM).
• This represents the first reported case of EV-D68 infection causing severe neurological manifestations in an adult kidney transplant recipient.
• The patient showed slow but steady improvement with intensive physical therapy and supportive care, maintaining stable kidney allograft function.

Implications:

• This case underscores the potential for EV-D68 to cause severe neurological disease, including AFP and ADEM, in immunocompromised adults.
• It highlights the need for heightened clinical suspicion and diagnostic consideration of EV-D68 in transplant recipients presenting with neurological deficits following respiratory illness.
• Early recognition and supportive management, guided by ADEM principles, may lead to functional recovery in such cases, emphasizing the importance of continued monitoring of allograft function.