{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T08:40:02Z","timestamp":1756284002106,"version":"3.44.0"},"reference-count":10,"publisher":"BMJ","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ Case Reports"],"abstract":"<jats:p>West Nile virus (WNV) is still the most common cause of neuroinvasive arboviral disease in the USA with a case death of 10\u201330%. We are reporting a case of a 61-year-old woman with a history of Crohn's disease, fibromyalgia treated with chronic steroid therapy that presented with a day history of fever, confusion and lethargy. She had a lumbar puncture which was notable for lymphocytosis and was positive for WNV. She initially was treated with broad-spectrum antibiotics, which were subsequently discontinued when the diagnosis of WNV neuroinvasive disease (WNND) was made. A high index of suspicion is needed to diagnose WNND, and this should be suspected in elderly immunocompromised patient presenting with altered mental status and lumbar puncture suggestive of aseptic meningitis. Recent study has showed that there is genetic variation in the interferon response pathway which is associated with both risk for symptomatic WNV infection and disease progression.<\/jats:p>","DOI":"10.1136\/bcr-2013-009238","type":"journal-article","created":{"date-parts":[[2013,6,28]],"date-time":"2013-06-28T14:57:40Z","timestamp":1372431460000},"page":"bcr2013009238","source":"Crossref","is-referenced-by-count":1,"title":["Altered mental status and fever"],"prefix":"10.1136","volume":"2013","author":[{"given":"Tokunbo","family":"Ajayi","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, North Shore Medical Center, Salem, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashmeet","family":"Bhatia","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, North Shore Medical Center, Salem, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbara","family":"Lambl","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, North Shore Medical Center, Salem, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Altamimi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, North Shore Medical Center, Salem, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2013,6,24]]},"reference":[{"key":"2025082701041756000_2013.jun24_1.bcr2013009238.1","first-page":"1009","article-title":"West Nile virus disease and other arboviral diseases\u2014United States, 2010","volume":"2013","author":"Centers for Disease Control and Prevention","year":"2011","journal-title":"MMWR"},{"key":"2025082701041756000_2013.jun24_1.bcr2013009238.2","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1007\/s11908-011-0193-9","article-title":"West Nile virus neuroinvasive disease","volume":"2013","author":"Debiasi","year":"2011","journal-title":"Curr Infect Dis Rep"},{"key":"2025082701041756000_2013.jun24_1.bcr2013009238.3","doi-asserted-by":"crossref","first-page":"471","DOI":"10.4269\/ajtmh.1940.s1-20.471","article-title":"A neurotropic virus isolated from the blood of a native Uganda","volume":"2013","author":"Smithburn","year":"1940","journal-title":"Am J Trop Med Hyg"},{"key":"2025082701041756000_2013.jun24_1.bcr2013009238.4","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/S0022-510X(02)00135-1","article-title":"Neurological features of West Nile virus infection during the 2000 outbreak in a regional hospital in Israel","volume":"2013","author":"Klein","year":"2002","journal-title":"J Neurol Sci"},{"key":"2025082701041756000_2013.jun24_1.bcr2013009238.5","doi-asserted-by":"crossref","unstructured":"Danis K Papa A Papanikolaou E . Ongoing outbreak of West Nile virus infection in humans, Greece, July to August 2011. 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