The natural history of West Nile virus infection presenting with West Nile virus meningoencephalitis in a man with a prolonged illness: a case report.

INTRODUCTION: Estimates indicate that West Nile virus infects approximately one and a half million people in the United States of America. Up to 1% may develop West Nile virus neuroinvasive disease, in which infected patients develop any combination of meningitis, encephalitis, or acute paralysis. CASE PRESENTATION: A 56-year-old African-American man presented to our hospital with headache, restlessness, fever, myalgias, decreased appetite, and progressive confusion. A cerebrospinal fluid examination showed mild leukocytosis and an elevated protein level. Testing for routine infections was negative. Brain T2-weighted magnetic resonance imaging scans showed marked enlargement of caudate nuclei and increased intensity within the basal ganglia and thalami. A West Nile virus titer was positive, and serial brain magnetic resonance imaging scans showed resolving abnormalities that paralleled his neurological examination. CONCLUSION: This report is unusual as it portrays the natural history and long-term consequences of West Nile virus meningoencephalitis diagnosed on the basis of serial brain images.

Emphysematous gastritis.

Emphysematous gastritis is a rare condition in which gas collects within the stomach wall secondary to infection by gas-producing organisms. The authors report a case of an 82-year-old diabetic man admitted for altered mental status, fever, and leukocytosis. Intramural air within the gastric wall was incidentally found by computed tomography. The case is discussed and differential diagnosis, early diagnosis, and outcome are reviewed.