Successful Recovery From West Nile Virus Meningitis In Heart Transplant Recipient.

West Nile Virus (WNV) has been known to have devastating outcomes in solid organ transplant (SOT) recipients; we report successful resolution of WNV at our institution. A 58 year old man status post heart transplant July 2017 presented to an outside hospital for a 3 day onset of fever, nasal congestion & a severe headache. Of note, patient was bitten by a mosquito 2 weeks prior. Upon arrival at our institution, workup was initiated to identify causative organisms. Nares influenza swab, viral panels, & blood cultures were negative. Chest radiograph, CT chest, Head & sinuses were all unremarkable. Cerebrospinal fluid (CSF) had high white blood cell count, but was negative for Meningitis, AFB, fungal or yeast elements. WNV IgM in Blood & CSF was positive for WNV Meningitis. Empiric antibiotics & antivirals started on admission were stopped. He was treated with two doses of intravenous immunoglobulin (IVIG). Immunosuppressants were significantly reduced. Mycophenolate (MMF) was discontinued & tacrolimus (FK) dose was reduced. Supportive therapy with intravenous fluids & antipyretics as needed. Patient remained febrile with maximum temperature of 102 & finally defervesced after one week. He gradually improved symptomatically, & was discharged 8 days after admission. MMF was restarted 10 days after discharge at a reduced dose. FK dose was also gradually increased to baseline regimen. Headaches, nausea, & fatigue persisted for about one month, during which time nonessential medications were held. Patient improved subsequently has remained stable to date. WNV infection is associated high mortality & morbidity in SOT patients. The WNV endemic in the US effects warmer states from July to October. WNV may be transmitted to SOT recipients at the time of SOT, by transfusion, or infected mosquito bite. This case highlights the possibility of survival & successful resolution of WNV infection with early recognition, minimization of immunosuppression, & supportive therapy with IVIG. [ABSTRACT FROM AUTHOR]