Pediatric Acute Liver Failure During the Pandemic: A Tale of Two Viruses

• DOI: 10.32873/unmc.dc.gmerj.5.1.062
• Publication Date: 2023-07-06T13:50:20Z
• Authors: Joslynn Hoburg; Anthony Bernicchi; Lisa Sieczkowski; Saher Aslam; E Magliulo; Kirk Foster; Prasanth Ravipati; Priscilla Rosa-Ni...; Robert Borucki; Dillon Clarey; Melodi Javid Whitley
• Keywords: Pandemic

Background: Endemic to the United States, West Nile virus is an arbovirus that primarily transmitted through bites of Culex mosquito.While most infections are asymptomatic, 20% -40% infected individuals develop flu-like symptoms and a smaller portion neuroinvasive disease.Neurologic involvement increases risk mortality can cause long-term neurologic sequala.Case: This case involves 17 y/o male with depression who presented emergency department for concerns anorexia.On admission he was febrile unable orient self or location.Sedated brain MRI LP were promptly performed evaluation meningitis.MRI imaging consistent encephalitis, but vascular infarct also considered.Cerebral spinal fluid (CSF) showed leukocytosis elevated protein, negative meningitis/ encephalitis panel.Initial treatment included ASA, vancomycin, ceftriaxone, acyclovir.Due persistent fevers new information frequent night fly-fishing over summer, additional workup performed.Results significant positive IgM antibody in CSF.He transitioned doxycycline complete empiric 7-day course.The patient's mental status slowly improved baseline discharged home close follow-up. Conclusion:West should be considered cases especially when factors, such as regional location outdoor hobbies, present.In areas high risk, prevention education encouraged.Additionally, this illustrates importance adjusting differential symptomology patient evolves.