What question did this study set out to answer?

To present a rare case of severe neurological decline following West Nile Virus infection, complicated by transverse myelitis and vasculitis.

May 20, 2026

C50-33 West Nile Myelitis: An Atypical Case of Post-Infectious Quadriplegia and Vasculitis

Key Points

To present a rare case of severe neurological decline following West Nile Virus infection, complicated by transverse myelitis and vasculitis.
Case analysis of a 26-year-old male presenting with ascendant neurological symptoms post-viral infection.
Diagnosis confirmed through MRI, CT scans, and extensive infectious disease investigation.
Treatment involved high-dose IV steroids, antibiotics, and plasmapheresis.
Patient developed quadriplegia and required respiratory support despite aggressive treatment initially.
Complications included neurogenic bladder, rhabdomyolysis, and severe pneumonia due to Klebsiella pneumoniae.
Cerebrospinal fluid showed West Nile Virus IgG, indicating CNS involvement.

Abstract

Abstract Introduction West Nile Virus infection is often asymptomatic, but when symptoms appear, they typically present as a mild, flu-like illness. More severe neuroinvasive disease sometimes occurs, and involves the central nervous system (CNS), characterized by high fever, headache, neck stiffness, tremors, confusion, and gait instability. Here we present a case of a 26-year-old who developed a severe, ascending neurological syndrome following a non-specific upper respiratory infection. Case A 26-year-old male cruise ship worker presented with urinary retention and ascending bilateral lower extremity weakness one week after a viral prodrome. Initial CT scans were negative for compression, but an urgent MRI of the cervical spine revealed extensive transverse myelitis, leading to the immediate initiation of high-dose IV steroids, broad antimicrobial antibiotics, and subsequent plasmapheresis. Despite early immunotherapy, his condition continued to deteriorate with progression to quadriplegia, necessitating eventual gastrostomy tube placement and tracheostomy due to acute respiratory failure. His course was complicated by a neurogenic bladder, rhabdomyolysis, and recurrent severe pneumonia caused by Klebsiella pneumoniae. Extensive infectious disease investigation revealed positive antibodies for Mycoplasma pneumoniae, as well as CSF detection of West Nile Virus IgG antibody. MRI findings were suspicious for CNS vasculitis. Despite completing maximal, multi-modal treatment, the patient's profound neuromuscular deficit remained unchanged, requiring continued ventilator and full supportive care. Discussion This case represents a rare outcome from a presumed post-infectious, possibly West Nile or Mycoplasma associated, severe transverse myelitis complicated by an atypical vasculitic component. The patient's rapid neurological decline and profound autonomic and respiratory failure underscore the destructive potential of these rare inflammatory conditions. Ultimately, this case highlights the critical necessity of considering rare presentations and maintaining a broad, aggressive treatment strategy—including both immunotherapy and broad antimicrobial coverage—in patients with rapidly progressing, life-threatening neuro-critical illness. This abstract is funded by: None

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