Bilateral Upper Extremity Tremors in West Nile Encephalitis

West Nile encephalitis is a rare complication of infection from the West Nile virus (WNv). Viral encephalitis can mimic manifestations of other neurologic diseases. The purpose of this article is to report a case of a 60-year-old female who developed bilateral upper extremity tremors with West Nile encephalitis. She presented to a hospital in Southern Louisiana with persistent high fevers and new onset confusion. She soon developed tremors which persisted throughout her hospitalization. Computerized tomography (CT) of the head revealed no abnormalities. Cerebral spinal fluid (CSF) was remarkable for WNv IgM, and supportive care was pursued. After nearly three weeks, she was transferred to a skilled nursing facility for further care. The presentation of movement disorder with confusion usually raises concern for injury to the brain or spinal cord or other neurologic illnesses. Despite the presentation of movement disorders or other neurologic manifestations, viral etiologies should remain high on the differential when the patient has additional symptoms, such as fever and elevated white blood cell (WBC) count, to limit inappropriate diagnostic testing and treatment.