West Nile virus encephalitis in a young immunocompetent female in Omaha Nebraska

One of the most common cause of arbovirus encephalitis in the United States of America (USA) is West Nile virus (WNV). In immunocompetent hosts, 70-80% of infected individuals have subclinical disease. However, in less than 1% of people infected by WNV it can become fulminant neuroinvasive disease associated with neurological morbidity. Herein, we discuss a case of neuroinvasive WNV disease with non-specific symptoms in an immunocompetent young female in Omaha. Our patient survived the acute phase of WNV encephalitis but has extended recovery to daily functioning. We also reviewed literature on WNV cases in immunocompetent individuals and to the best of our knowledge only 3 cases have been reported to date. The difference between reported cases and our case is her younger age, bilateral upper and lower extremity paralysis, 30 day hospitalization with significant morbidity leading to a prolonged stay at rehabilitation facility with residual cognitive and gross motor impairment. Usually WNV is not considered a differential in immunocompetent individuals which leads to delay in diagnosis, management and therefore increases mortality and morbidity. Therefore purpose of our case report is to raise awareness of atypical presentations of WNV infection in immunocompetent individuals in non-endemic area to emphasize the importance of early diagnosis and management.