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West Nile virus (WNV) has been responsible for multiple outbreaks and has shown evolution in its clinical manifestation. The Centers for Disease Control and Prevention has provided diagnostic criteria in classifying the variety of WNV infection; however, application of these criteria can prove challenging during outbreaks, and understanding the array of presentations and patient population is clinically important. In this article, we present the challenges encountered during the 2012 outbreak at one institution.
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We present two patients with a high viral load of HIV-1 who developed symptoms of ascending paralysis leading to respiratory failure and autonomic instability. One patient had symptom improvement with highly active antiretroviral therapy (HAART) and a subsequent decrease in viral load. The other patient improved with intravenous immunoglobulin therapy and did not show much improvement on HAART alone. There are several proposed mechanisms for peripheral neuropathies seen in HIV-infected patients, including a direct action of HIV on the nerve by neurotropic strains or formation of autoantibodies against nerve elements. The comparison of the response to different therapies in these two cases highlights the importance of understanding different pathophysiologies, as the treatment modality may differ.
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A case of herpes simplex virus (HSV) meningitis complicated by ascending paralysis with almost complete recovery following antiviral treatment is reported. We present this case to illustrate the importance of including HSV-induced neuropathy in the differential diagnosis of acute neurologic symptoms following the viral illness.
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Unilateral eye swelling, redness, and pain may represent a diagnostic challenge to many clinicians. The differential diagnosis is broad and includes both nonemergent and emergent diagnoses. While the emergent diagnoses must be made and treatment initiated immediately, the nonemergent differential also includes life- and vision-threatening entities. The diagnosis of idiopathic orbital inflammatory syndrome (IOIS) is characterized by acute-onset, typically unilateral periorbital swelling, chemosis, and proptosis. It can be differentiated from other entities by radiologic findings and rapid response to corticosteroids; however, it is often a diagnosis of exclusion. We report a case-based discussion including distinguishing features, diagnostic modalities, and treatment of similar entities involving periorbital/orbital edema and conjunctival injection complicated by a past medical history of breast cancer.
