Objective:

To describe a rare case of ischemic stroke in a young adult with concurrent West Nile virus (WNV) neuroinvasive disease and recent kratom use, highlighting the diagnostic complexity of overlapping vasculopathic mechanisms.

Background:

WNV is an uncommon but recognized cause of neuroinvasive disease and has been associated with ischemic stroke through immune-mediated endothelial injury and inflammatory vasculopathy. Kratom (Mitragyna speciosa), an unregulated botanical supplement with opioid and sympathomimetic properties, has been linked to vasospasm and hypercoagulability in isolated reports. Coexistence of these exposures presents a unique diagnostic challenge when evaluating stroke in young adults.

Design/Methods:

N/A

Results:

A 41-year-old woman with hypertension, diabetes, and chronic high-dose kratom use (approximately 25–50 g daily, discontinued three days prior) presented after five days of fever and vomiting, followed by acute right-arm weakness. On arrival, she was intermittently combative but alert, with mild right-sided weakness and nuchal rigidity. Brain MRI revealed an acute left thalamic infarct. Cerebrospinal fluid showed lymphocytic pleocytosis (102 WBC/µL), elevated protein (67.7 mg/dL), and normal glucose (102 mg/dL). Empiric antimicrobials were initiated for suspected meningoencephalitis but discontinued after negative cultures and confirmation of WNV infection by serologic testing. CTA and MRA of the head and neck demonstrated patent intracranial vessels without angiographic vasculitis, and echocardiography was unremarkable. The constellation of fever, CSF pleocytosis, and focal infarction supported WNV-associated vasculitis as the primary mechanism, though kratom-induced vasospasm or hypercoagulability could not be excluded. She improved gradually with supportive care.

Conclusions:

This case underscores the diagnostic complexity of ischemic stroke in the context of concurrent neuroinvasive viral infection and recent kratom exposure. WNV-associated vasculitis was the most likely mechanism, but kratom-related vascular effects may have contributed. Clinicians should maintain vigilance for multifactorial vasculopathies in young stroke patients and recognize emerging cerebrovascular risks associated with kratom use.