Case history
Case history
A 50-year-old man presents with a history of a sudden onset of fever, headache, fatigue, myalgia, and generalised arthralgia. He has spent much of the summer months outdoors and recalls being bitten by mosquitoes. On examination, the patient is pyrexial, has a maculopapular rash involving the trunk and extremities, and has sub-mental lymphadenopathy.
Other presentations
Patients may also present with ocular symptoms (e.g., eye pain, visual disturbances, conjunctival injection, multi-focal chorioretinal lesions, retinal haemorrhages), pharyngitis, generalised muscle weakness, nausea/vomiting, splenomegaly, or signs and symptoms of complications including pancreatitis (e.g., epigastric pain), myocarditis (e.g., dyspnoea, chest pain, palpitations), or hepatitis (e.g., right upper quadrant pain, jaundice).
Rarely, patients may develop neuroinvasive disease, which can present with signs and symptoms of encephalitis (e.g., stupor, coma), meningitis (e.g., photophobia, stiff neck, Kernig's sign, Brudzinski's sign), or West Nile poliomyelitis (i.e., a syndrome characterised by acute flaccid paralysis that resembles poliomyelitis).
Hepatitis, pancreatitis, and myocarditis are all rare complications.
Cases of congenital infection have been reported in pregnant women who are infected with West Nile virus during pregnancy; however, the risk for adverse pregnancy and newborn outcomes appears to be low.[2]
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