Abstract
West Nile virus infection poses a significant threat, especially during the warmer months when mosquitoes are abundant. Clinicians must remain vigilant for neuroinvasive illness in patients presenting with febrile symptoms and malaise following mosquito exposure. While magnetic resonance imaging and cerebrospinal fluid analysis aid in differential diagnosis, detecting West Nile immunoglobulin M in serum is crucial for definitive diagnosis. Treatment primarily involves supportive care due to the absence of established regimens, though promising outcomes have been reported with plasma exchange and intravenous immunoglobulin. We present the case of an 83-year-old resident of Alabama, an avid gardener living near a pond, who initially exhibited symptoms of productive cough, diarrhea, fever, and generalized malaise. However, within 48 h, he developed hypoxemia, functional quadriplegia, and bulbar palsy necessitating intubation. Diagnostic evaluations, including magnetic resonance imaging and positive West Nile virus immunoglobulin M in serum, confirmed West Nile virus-associated poliomyelitis viral syndrome, prompting intravenous immunoglobulin therapy. This case highlights the importance of promptly identifying and managing West Nile virus infection, especially in regions susceptible to mosquito-borne diseases, and being vigilant of the disease in non-endemic regions. The case also begs the question of the timing and efficacy of intravenous immunoglobulin and plasma exchange in West Nile virus infection and the fact that more data should be collected on these therapies.