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West Nile virus, a mosquito-borne flavivirus, was first isolated in the country of Uganda in 1937 and later in other regions of Africa, Asia, and Europe. Before the outbreak in the greater New York area in the late summer of 1999, no human West Nile virus case had been reported in North America.1 In the past, West Nile fever has manifested as a systemic illness involving acute fever, myalgia, headache, lymphadenopathy, and maculopapular rash.2 However, in 1 to 40% of cases there has been infection of the neuroaxis, including encephalitis, meningitis, myelitis, radiculopathy, and peripheral neuropathy.3,4 We describe an adolescent with West Nile encephalitis with brainstem manifestations.
Case report.
A healthy 15-year-old boy presented with a 3-day history of fever, headache, vomiting, and confusion. Recent history was remarkable for multiple insect bites while living in the Bronx and during a visit to Rhode Island in July 1999. History was negative for immunosuppression, systemic illness, rashes, vaccinations, trauma, or drug use. The patient was hospitalized in the Bronx on September 5, 1999. Pertinent laboratory investigations …
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