Eastern equine encephalomyelitis with hematuria and bladder dysfunction

We have described a patient with eastern equine encephalomyelitis acquired in central Virginia, an area in which EEE is not ordinarily considered endemic. The unusual presenting features of our patient's encephalomyelitis were bladder dysfunction and hematuria as well as prominent mood and affect disturbances, which are usually seen in association with St. Louis encephalitis. The diagnosis of arboviral encephalomyelitis was considered because of the severe CNS manifestations and spinal cord involvement, and was facilitated by the detection of specific IgM antibodies in both the CSF and serum. A high index of suspicion is required to make the diagnosis of EEE, especially in nonendemic areas.