Acute Fever of Unknown Origin: A Presentation of West Nile Encephalitis.

INTRODUCTION: West Nile virus is an asymptomatic infection in most cases, but it can present with a rare complication of deadly neuroinvasive disease. CASE PRESENTATION: A 81-year-old White man presented with altered mental status and fever of unknown origin. After extensive workup, he was diagnosed with West Nile encephalitis based on positive serology, lumbar puncture, and clinical presentation. DISCUSSION: West Nile virus is a mosquito-borne RNA arbovirus that, in rare cases, can lead to encephalitis, which is a challenging diagnosis. There is no current treatment; however, a 5-day course of intravenous immunoglobulin seemed to show acute clinical improvement in both mentation and magnetic resonance imaging of the head and no long-term effects. CONCLUSION: We report this case to increase awareness among clinicians to include West Nile virus in the differential diagnosis of encephalitis with fever of unknown origin, particularly in endemic areas.

COVID or Not COVID? A Great Mimicker Behind the Smoke Screen.

Vaping is becoming increasingly popular as an alternative to cigarettes. However, vaping does not come without risks; electronic cigarette (e-cigarette) and vaping-associated lung injury (EVALI) is one of the most severe consequences. Coronavirus disease 2019 (COVID-19) and bacterial pneumonia cases often present with almost identical features. We present a case of a young man who presented with pneumonia that was initially thought to be related to COVID-19 infection but later diagnosed as EVALI. Clinicians should have a high suspicion of EVALI in patients who present with hypoxemia and negative infectious workup, particularly during the COVID-19 era. Administration of corticosteroids has shown remarkable efficacy in improving hypoxemia; however, many patients may have chronic lung injury and may require oxygen long-term. Cases of EVALI should continue to be reported and followed up long term for monitoring disease outcomes.