Rapidly progressive neurologic decline and morbilliform rash presenting in a patient with lymphoma

  • Dean Ehrlich | dsehrlich@mednet.ucla.edu Ronald Reagan UCLA Medical Center, University of California, Los Angeles, CA, United States.
  • Jennifer Phan Ronald Reagan UCLA Medical Center, University of California, Los Angeles, CA, United States.
  • Gavin Hui Ronald Reagan UCLA Medical Center, University of California, Los Angeles, CA, United States.
  • Alexandra Drakaki Ronald Reagan UCLA Medical Center, University of California, Los Angeles, CA, United States.

Abstract

A 67-year-old male with past medical history of mantle cell lymphoma and atrial fibrillation presented with a truncal rash, bilateral lower extremity weakness, and confusion. Within three days of presentation, his condition rapidly deteriorated with the onset of diffuse flaccid paralysis, aphasia, and severe alteration in mental status. Initial results from serum studies, lumbar puncture, magnetic resonance imaging, and electroencephalogram were not diagnostic. However, on the ninth day after initial presentation, the West Nile Virus (WNV) immunoglobulin M antibody returned positive from the cerebrospinal fluid. West Nile Virus encephalitis is endemic worldwide, and is the most common viral encephalitis in the United States. WNV presents in a variety of ways, and the recognition by physicians is crucial due to the estimated 2- 12% mortality rate and significant longterm morbidity of neuroinvasive disease. The initial management and long term prognosis are points of ongoing research. This case represents a particularly profound example of neuroinvasive WNV. Our patient made a significant recovery after his initial presentation with aggressive supportive care, however still suffers from bilateral lower extremity weakness more than a year later.

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Published
2018-12-04
Section
Case Reports
Keywords:
Lymphoma, Neurologic decline, Morbilliform rash
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How to Cite
Ehrlich, D., Phan, J., Hui, G., & Drakaki, A. (2018). Rapidly progressive neurologic decline and morbilliform rash presenting in a patient with lymphoma. Clinics and Practice, 8(4). https://doi.org/10.4081/cp.2018.1097