West Nile virus infection in a renal transplant recipient.

This case represents the need for total teamwork in the assessment, diagnosis, and treatment of an immunosuppressed patient with a viral syndrome. One of the most striking features of this case study is the importance of a thorough history of current events and exposures in determining the list of potential diagnoses. The systematic process of laboratory evaluations to determine viral activity in an immunosuppressed patient is paramount in identifying the actual culprit responsible for the myriad of clinical symptoms at presentation. The symptomatology would guide one to the common viruses, but the travel history was the clue to testing for an uncommon etiology. The input from family members relating to the progression of mental status changes was also an important part of the current medical history. Along with supportive treatment, the patient was also given a course of interferon alpha as part of an experimental protocol. The support of the family during this decision-making process was an important function of the entire team. The patient was unable to participate in this decision and the family required a great deal of discussion regarding the pros and cons of their decision. For this patient, the outcomes were excellent. He has stable renal function, has no neurologic residual, and is back to his baseline physically and psychologically. An important recommendation based on this case is to provide educational materials to all transplant patients on viral illnesses. Topics covered should include modes of transmission, symptomatology, and the consequences of the illness. The CDC has excellent materials on West Nile Virus that can be downloaded and provided to all patients. In addition, a thorough medical history should always be obtained including possible exposures and recent travel.