An 81 year-old male with chronic pain was admitted to the hospital with increasing weakness, nonbloody diarrhea, emesis, and fever the days prior. He presented afebrile, alert and oriented, with unremarkable labs. The following morning, he had two seizures and received lorazepam and levetiracetam load prior to intubation and transfer to a quaternary care hospital. He presented afebrile with WBC of 15, which normalized over the next few days. Upon arrival, he was not following commands and had slight withdrawal of extremities to pain. Initial EEG showed slow, poorly organized, poorly reactive background with no seizures or epileptiform discharges. MRI showed diffusion restriction in the lateral ventricles, prompting empiric treatment for presumed ventriculitis. Lumbar puncture was notable for  glucose 54, protein 248, and WBC 124 with 48% lymphocytes. On day two of admission, the patient became persistently febrile to 39°C and intermittently tachypneic. HIV testing was negative. He tested positive for West Nile Virus (WNV) IgG/IgM in serum and WNV IgG in CSF, with positive WNV PCR. St. Louis Encephalitis Virus (SLEV) IgG was also positive in serum. IVIG and dexamethasone were started and antimicrobials discontinued. After two weeks of little improvement, he was extubated, transitioned to comfort measures, and died the next day.