A man in his 70s was admitted to our hospital with complaints of fatigue, loss of appetite and fever. His neurological examination was normal. He had a medical history of diabetes mellitus for 25 years. Urine analysis showed many leucocytes. Empirical antibiotic treatment was started for urinary system infection. Three days later, his mental status worsened with confusion and disorientation. MRI of the brain was normal. Two days later, the patient was intubated because of respiratory insufficiency. MRI showed restricted diffusion in bilateral thalamic nuclei. Encephalitis and ischaemia were considered in the differential diagnosis. Cerebrospinal fluid IgM antibody for West Nile virus was positive. Sixteen days later, cranial nerve reflexes were lost. MRI showed restricted diffusion and increased T2 signal intensity in the dorsal medulla and increased T2 signal intensity without diffusion restriction in bilateral substantia nigra and dentate nuclei. He died of cardiac arrest 40 days after hospitalisation.
- Infection (neurology)
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Contributors ED and CAT were involved in the patient’s care including diagnosis, drafted the manuscript and designed the figures. BA and YA contributed to drafting the manuscript and revising it critically for important intellectual content. All of the authors declare that they have all participated in the design, execution and analysis of the paper, and that they have approved the final version.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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