EMG Confirmed Axon Motor Polyneuropathy in a Patient with West Nile Virus: A Case Report
Paul Partyka1, Rajesh Burela1, Hope Okpokam1, Daniel Kaufman2, Sumera Salma3, Yakov Isakov1, Alexandr Safarov1, Paul Wright1
1Nuvance Health, 2Touro University College of Osteopathic Medicine, 3Jinnah Medical & Dental College
Objective:
We present a case report of a patient who developed acute quadriplegia in the setting of West Nile Virus (WNV) and consistent with WNV Poliomyelitis.
Background:
WNV induced polyneuropathy is a rare clinical scenario with few case reports documented. WNV infection with acute weakness presents as a poliomyelitis-like syndrome with acute onset of asymmetric weakness and areflexia without any sensory abnormalities. Unfortunately, patients with WNV infection who develop neuromuscular manifestations have a high rate of morbidity and mortality.
Design/Methods:
The patient is a 49-year-old male with no past medical history who immigrated from Mexico three days prior to presenting to our hospital with a three-day rapid worsening asymmetric weakness in all four extremities. On exam, patient was in no significant distress, however had significant flaccid tone as well as quadriplegia and areflexia in all four extremities. MRI brain and spine were unrevealing for an acute process. He was treated with five days of IVIG for presumed Guillaine-Barre (GBS), however patient failed to improve clinically and deteriorated requiring intubation for respiratory failure. Initial LP performed within 24 hours of presentation was normal. WNV antibody serum screen was however positive. EMG of the medial, ulnar, and radial nerves demonstrated a predominantly axon motor polyneuropathy and absent compound muscle action potentials (CMAP). Ultimately the patient required a tracheostomy and PEG tube. Due to lack of clinical improvement, he underwent six sessions of plasmapheresis after which his strength gradually improved to 3/5. His respiratory function improved, and he was sent to a long term assisted care facility.
Conclusions:
Differentiating between WNV poliomyelitis and GBS is challenging. This case report emphasizes key features seen in WNV poliomyelitis such as acute onset of asymmetric weakness without sensory symptoms as well as electrodiagnostic features of motor axon loss with reduced/absent CMAPs to aide in the diagnosis.