1600 - West Nile neuroinvasive disease complicated by Guillain-Barré syndrome

West Nile neuroinvasive disease complicated by Guillain-Barré syndrome 

Case Description:

A 69-year-old man with atrial fibrillation, diabetes, hypertension, and neuropathy presented with generalized weakness, fevers, and tremors. Initial infectious workup was unrevealing, with negative cultures and imaging notable only for mild enteritis and bibasilar opacities. Despite broad-spectrum antibiotics, he developed worsening encephalopathy, diffuse rash, and action tremors. Serum West Nile virus antibody returned positive. Hospital course was complicated by acute kidney injury, right brachial vein DVT, and progressive neuromuscular weakness requiring ICU care. Neurology evaluation and electrodiagnostic studies supported Guillain-Barré syndrome in the context of West Nile virus infection. He required tracheostomy and a gastrostomy tube for respiratory failure and dysphagia. Subsequent recovery was protracted and complicated by gangrenous cholecystitis, multidrug-resistant bacteremia, and small bowel obstruction. Following surgery, wound care, and prolonged inpatient rehabilitation, he demonstrated gradual improvement in strength, swallowing, and mobility.

Discussions:

West Nile neuroinvasive disease (WNND) most commonly manifests as encephalitis, meningitis, or acute flaccid paralysis from anterior horn cell involvement. Less frequently, WNV triggers demyelinating neuropathies such as Guillain-Barré syndrome (GBS), typically presenting 1-8 weeks post-infection with symmetric ascending weakness and autonomic dysfunction. Distinguishing WNV-associated GBS from poliomyelitis-like paralysis is critical, as prognosis differs. Long-term outcomes are variable, with up to half of patients with WNND reporting persistent fatigue, weakness, or cognitive deficits. Recovery from WNV-associated GBS may take years and is often incomplete. This patient’s prolonged course illustrates both neurological sequelae of WNND and the vulnerability to secondary complications, including infection, immobility-related morbidity, and nutritional decline. 

Conclusions:

This case highlights WNND complicated by Guillain-Barré syndrome, with prolonged neurological and medical sequelae. Clinicians should recognize GBS as a potential post-infectious complication of WNV, anticipate prolonged recovery, and implement multidisciplinary care to optimize outcomes and mitigate secondary complications.