A Fatal Case of Powassan Virus Encephalitis

The Powassan virus (POWV) is part of the Flaviviridae family. It is mainly transmitted via tickbite but can rarely be spread person-to-person through blood transfusions. Initial symptoms include fever, headache, and vomiting. It can cause severe symptoms, including confusion, aphasia, and seizures. Approximately 1 out of 10 people with severe disease die. From 2010 to 2020, 194 Powassan virus cases have been reported to the Center for Disease Control (CDC), with 22 of them resulting in death. In this case report, we discuss a 39-year-old female who presented with fever, myalgia, and confusion. During her hospitalization, she developed tonic-clonic seizures, which required sedation and intubation. A central venous catheter was inserted due to poor intravenous access, and in the process of placing it, the provider sustained a needle stick injury. The patient was eventually diagnosed with POWV encephalitis and transferred to a higher level of care, where a brain perfusion study showed an absence of brain flow consistent with brain death. After a discussion with the family, the decision was made to extubate the patient terminally. The provider who sustained the needle stick injury reported no concerning symptoms two years after the event.