Atypical Eastern Equine Encephalitis in an Immunocompromised Patient: Diagnostic Challenges With Unique MRI Findings
Zhimin Xu1, Subhan Khan1, Ahya Ali1, Terry Park1, Fang Yu1, Jon Rosenberg1, Fawaz Al-Mufti1
1Westchester Medical Center
Objective:
To highlight the diagnostic complexity of Eastern equine encephalitis (EEE) in immunocompromised patients and examine how atypical imaging and CSF findings can delay identification.
Background:
EEE is a rare but often fatal arboviral infection. Immunocompromised individuals may present atypically, complicating diagnosis and delaying treatment.
Results:
A 64-year-old man with multiple myeloma presented with fever, seizures, and coma. CSF showed a shift from neutrophilic to lymphocytic pleocytosis. Standard viral and autoimmune panels were negative. MRI brain revealed cortical and subcortical diffusion restriction rather than classic deep gray matter involvement of arboviral infection. EEE virus RNA was eventually detected by a state-specific PCR panel. Despite treatment, the patient deteriorated neurologically and transitioned to comfort care. Postmortem confirmed encephalitis. This case marks the first reported instance of EEE in New York State in the past decade.
Conclusions:
EEE can present with non-classical imaging and diagnostic findings in immunosuppressed hosts. Broader diagnostic approaches and earlier empiric treatment may improve outcomes.
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