Mary Wilson
Well-known member
Volume: 21 Issue: 1 January 2023
Pages: 59 - 62
DOI :10.6002/ect.2022.0226
Milos Stulic,[SUP]1[/SUP] Djordje Culafic,[SUP]1[/SUP] Jelena Jordovic,[SUP]2[/SUP] Milica Culafic,[SUP]3[/SUP] Natasa Petrovic,[SUP]4[/SUP] Ivan Stojimirov,[SUP]4[/SUP] Zlatibor Loncar[SUP]4[/SUP]
West Nile virus was first described in 1937 and has since periodically appeared in various parts of the world by infecting people and horses. Reported infection symptoms and signs may be highly variable, ranging from fever and myalgias to meningoencephalitis. A 59-year-old patient was admitted to the University Clinical Centre of Serbia, Belgrade, in September 2018, where liver transplant was performed to treat cirrhosis of ethyl etiology. Immunosuppressive therapy was started immediately after successful transplant, with the patient receiving methylprednisolone, tacrolimus, and mycophenolate mofetil. Mycophenolate mofetil was excluded from therapy on postoperative day 3 because of progressively worse white blood cell count. The patient became febrile on postoperative day 11 (39.6 °C), and arm tremor, nausea, vomiting, and frequent fluid stools occurred. He complained of pain in the muscles and joints of the lower extremities. The next day he experienced occasional disorientation. Neurological findings revealed no signs of acute focal neurological deficit. We performed culture tests to isolate pathological microorganisms, and results were negative in cultures of the blood, urine, feces, ascites, and a smear of the wound and tip of the central venous catheter. Lumbar puncture resulted in a clear cerebrospinal fluid that was sent for analysis that showed significant increases in white blood cell count (94 × 10[SUP]6[/SUP] cells/L), total proteins (1.61 g/L), and microalbumin (504.5 mg/L), with a reduction of immunoglobulin G. On postoperative day 15, positive serology of West Nile virus immunoglobulin M in cerebrospinal fluid was verified. Intensive monitoring and symptomatic and supportive therapy resulted in clinical and laboratory improvement, and the patient was discharged in good general condition on postoperative day 22. Considering the high risk of posttransplant complications, there remains the question of whether all donors and recipients should be tested for West Nile virus at the onset of transplant.
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