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Rapidly progressive neurologic decline and morbilliform rash presenting in a patient with lymphoma

A 67-year-old male with past medical history of mantle cell lymphoma and atrial fibrillation presented with a truncal rash, bilateral lower extremity weakness, and confusion. Within three days of presentation, his condition rapidly deteriorated with the onset of diffuse flaccid paralysis, aphasia, a...

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Autores principales: Ehrlich, Dean, Phan, Jennifer, Hui, Gavin, Drakaki, Alexandra
Formato: Online Artículo Texto
Lenguaje:English
Publicado: PAGEPress Publications, Pavia, Italy 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6291742/
https://www.ncbi.nlm.nih.gov/pubmed/30613373
http://dx.doi.org/10.4081/cp.2018.1097
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author Ehrlich, Dean
Phan, Jennifer
Hui, Gavin
Drakaki, Alexandra
author_facet Ehrlich, Dean
Phan, Jennifer
Hui, Gavin
Drakaki, Alexandra
author_sort Ehrlich, Dean
collection PubMed
description A 67-year-old male with past medical history of mantle cell lymphoma and atrial fibrillation presented with a truncal rash, bilateral lower extremity weakness, and confusion. Within three days of presentation, his condition rapidly deteriorated with the onset of diffuse flaccid paralysis, aphasia, and severe alteration in mental status. Initial results from serum studies, lumbar puncture, magnetic resonance imaging, and electroencephalogram were not diagnostic. However, on the ninth day after initial presentation, the West Nile Virus (WNV) immunoglobulin M antibody returned positive from the cerebrospinal fluid. West Nile Virus encephalitis is endemic worldwide, and is the most common viral encephalitis in the United States. WNV presents in a variety of ways, and the recognition by physicians is crucial due to the estimated 2-12% mortality rate and significant longterm morbidity of neuroinvasive disease. The initial management and long term prognosis are points of ongoing research. This case represents a particularly profound example of neuroinvasive WNV. Our patient made a significant recovery after his initial presentation with aggressive supportive care, however still suffers from bilateral lower extremity weakness more than a year later.
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spelling pubmed-62917422019-01-04 Rapidly progressive neurologic decline and morbilliform rash presenting in a patient with lymphoma Ehrlich, Dean Phan, Jennifer Hui, Gavin Drakaki, Alexandra Clin Pract Case Report A 67-year-old male with past medical history of mantle cell lymphoma and atrial fibrillation presented with a truncal rash, bilateral lower extremity weakness, and confusion. Within three days of presentation, his condition rapidly deteriorated with the onset of diffuse flaccid paralysis, aphasia, and severe alteration in mental status. Initial results from serum studies, lumbar puncture, magnetic resonance imaging, and electroencephalogram were not diagnostic. However, on the ninth day after initial presentation, the West Nile Virus (WNV) immunoglobulin M antibody returned positive from the cerebrospinal fluid. West Nile Virus encephalitis is endemic worldwide, and is the most common viral encephalitis in the United States. WNV presents in a variety of ways, and the recognition by physicians is crucial due to the estimated 2-12% mortality rate and significant longterm morbidity of neuroinvasive disease. The initial management and long term prognosis are points of ongoing research. This case represents a particularly profound example of neuroinvasive WNV. Our patient made a significant recovery after his initial presentation with aggressive supportive care, however still suffers from bilateral lower extremity weakness more than a year later. PAGEPress Publications, Pavia, Italy 2018-12-04 /pmc/articles/PMC6291742/ /pubmed/30613373 http://dx.doi.org/10.4081/cp.2018.1097 Text en ©Copyright D. Ehrlich et al., 2018 http://creativecommons.org/licenses/by-nc/4.0/ This work is licensed under a Creative Commons Attribution NonCommercial 4.0 License (CC BY-NC 4.0).
spellingShingle Case Report
Ehrlich, Dean
Phan, Jennifer
Hui, Gavin
Drakaki, Alexandra
Rapidly progressive neurologic decline and morbilliform rash presenting in a patient with lymphoma
title Rapidly progressive neurologic decline and morbilliform rash presenting in a patient with lymphoma
title_full Rapidly progressive neurologic decline and morbilliform rash presenting in a patient with lymphoma
title_fullStr Rapidly progressive neurologic decline and morbilliform rash presenting in a patient with lymphoma
title_full_unstemmed Rapidly progressive neurologic decline and morbilliform rash presenting in a patient with lymphoma
title_short Rapidly progressive neurologic decline and morbilliform rash presenting in a patient with lymphoma
title_sort rapidly progressive neurologic decline and morbilliform rash presenting in a patient with lymphoma
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6291742/
https://www.ncbi.nlm.nih.gov/pubmed/30613373
http://dx.doi.org/10.4081/cp.2018.1097
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