Rapidly progressive neurologic decline and morbilliform rash presenting in a patient with lymphoma
A 67-year-old male with past medical history of mantle cell lymphoma and atrial fibrillation presented with a truncal rash, bilateral lower extremity weakness, and confusion. Within three days of presentation, his condition rapidly deteriorated with the onset of diffuse flaccid paralysis, aphasia, a...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2018-12-01
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| Series: | Clinics and Practice |
| Subjects: | |
| Online Access: | https://www.clinicsandpractice.org/index.php/cp/article/view/1097 |
| _version_ | 1818037563836858368 |
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| author | Dean Ehrlich Jennifer Phan Gavin Hui Alexandra Drakaki |
| author_facet | Dean Ehrlich Jennifer Phan Gavin Hui Alexandra Drakaki |
| author_sort | Dean Ehrlich |
| collection | DOAJ |
| description | A 67-year-old male with past medical history of mantle cell lymphoma and atrial fibrillation presented with a truncal rash, bilateral lower extremity weakness, and confusion. Within three days of presentation, his condition rapidly deteriorated with the onset of diffuse flaccid paralysis, aphasia, and severe alteration in mental status. Initial results from serum studies, lumbar puncture, magnetic resonance imaging, and electroencephalogram were not diagnostic. However, on the ninth day after initial presentation, the West Nile Virus (WNV) immunoglobulin M antibody returned positive from the cerebrospinal fluid. West Nile Virus encephalitis is endemic worldwide, and is the most common viral encephalitis in the United States. WNV presents in a variety of ways, and the recognition by physicians is crucial due to the estimated 2- 12% mortality rate and significant longterm morbidity of neuroinvasive disease. The initial management and long term prognosis are points of ongoing research. This case represents a particularly profound example of neuroinvasive WNV. Our patient made a significant recovery after his initial presentation with aggressive supportive care, however still suffers from bilateral lower extremity weakness more than a year later. |
| first_indexed | 2024-12-10T07:28:50Z |
| format | Article |
| id | doaj.art-b63680f00f1c4138a2c8dcc4b8154bac |
| institution | Directory Open Access Journal |
| issn | 2039-7275 2039-7283 |
| language | English |
| last_indexed | 2024-12-10T07:28:50Z |
| publishDate | 2018-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Clinics and Practice |
| spelling | doaj.art-b63680f00f1c4138a2c8dcc4b8154bac2022-12-22T01:57:38ZengMDPI AGClinics and Practice2039-72752039-72832018-12-018410.4081/cp.2018.1097Rapidly progressive neurologic decline and morbilliform rash presenting in a patient with lymphomaDean Ehrlich0Jennifer Phan1Gavin Hui2Alexandra Drakaki3Ronald Reagan UCLA Medical Center, University of California, Los Angeles, CARonald Reagan UCLA Medical Center, University of California, Los Angeles, CARonald Reagan UCLA Medical Center, University of California, Los Angeles, CARonald Reagan UCLA Medical Center, University of California, Los Angeles, CAA 67-year-old male with past medical history of mantle cell lymphoma and atrial fibrillation presented with a truncal rash, bilateral lower extremity weakness, and confusion. Within three days of presentation, his condition rapidly deteriorated with the onset of diffuse flaccid paralysis, aphasia, and severe alteration in mental status. Initial results from serum studies, lumbar puncture, magnetic resonance imaging, and electroencephalogram were not diagnostic. However, on the ninth day after initial presentation, the West Nile Virus (WNV) immunoglobulin M antibody returned positive from the cerebrospinal fluid. West Nile Virus encephalitis is endemic worldwide, and is the most common viral encephalitis in the United States. WNV presents in a variety of ways, and the recognition by physicians is crucial due to the estimated 2- 12% mortality rate and significant longterm morbidity of neuroinvasive disease. The initial management and long term prognosis are points of ongoing research. This case represents a particularly profound example of neuroinvasive WNV. Our patient made a significant recovery after his initial presentation with aggressive supportive care, however still suffers from bilateral lower extremity weakness more than a year later.https://www.clinicsandpractice.org/index.php/cp/article/view/1097LymphomaNeurologic declineMorbilliform rash |
| spellingShingle | Dean Ehrlich Jennifer Phan Gavin Hui Alexandra Drakaki Rapidly progressive neurologic decline and morbilliform rash presenting in a patient with lymphoma Clinics and Practice Lymphoma Neurologic decline Morbilliform rash |
| title | Rapidly progressive neurologic decline and morbilliform rash presenting in a patient with lymphoma |
| title_full | Rapidly progressive neurologic decline and morbilliform rash presenting in a patient with lymphoma |
| title_fullStr | Rapidly progressive neurologic decline and morbilliform rash presenting in a patient with lymphoma |
| title_full_unstemmed | Rapidly progressive neurologic decline and morbilliform rash presenting in a patient with lymphoma |
| title_short | Rapidly progressive neurologic decline and morbilliform rash presenting in a patient with lymphoma |
| title_sort | rapidly progressive neurologic decline and morbilliform rash presenting in a patient with lymphoma |
| topic | Lymphoma Neurologic decline Morbilliform rash |
| url | https://www.clinicsandpractice.org/index.php/cp/article/view/1097 |
| work_keys_str_mv | AT deanehrlich rapidlyprogressiveneurologicdeclineandmorbilliformrashpresentinginapatientwithlymphoma AT jenniferphan rapidlyprogressiveneurologicdeclineandmorbilliformrashpresentinginapatientwithlymphoma AT gavinhui rapidlyprogressiveneurologicdeclineandmorbilliformrashpresentinginapatientwithlymphoma AT alexandradrakaki rapidlyprogressiveneurologicdeclineandmorbilliformrashpresentinginapatientwithlymphoma |