West Nile Viral Encephalitis in an HIV-Positive Woman in New York

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Abstract
We describe a 38-year-old woman with human immunodeficiency virus (HIV) infection and West Nile viral encephalitis. She had a CD4+ lymphocyte count of 351 per cubic millimeter, less than 50 copies of HIV RNA per milliliter on polymerase-chain-reaction assays, and was receiving lamivudine, nevirapine, and zidovudine. She presented with a one-week history of headache and fever and a three-day history of neck stiffness, photophobia, and vomiting. She lived in the Bronx, New York, and had not traveled outside the United States. On admission, she had a temperature of 40°C, nuchal rigidity without focal neurologic signs, and a white-cell count of 5300 per cubic millimeter (11 percent monocytes, 23 percent lymphocytes, and 65 percent granulocytes). A computed tomographic scan of the brain showed enhancement along the tentorium. A lumbar puncture revealed an opening pressure of 20 mm of water, 220 white cells per cubic millimeter (62 percent lymphocytes, 13 percent monocytes, and 25 percent granulocytes), 35 red cells per cubic millimeter, 64 mg of glucose per deciliter, and 50 mg of total protein per deciliter; Gram's staining showed 2+ polymorphonuclear cells. Cultures of cerebrospinal fluid, blood, and urine had no growth. Antibiotics were begun for presumed bacterial meningitis but were stopped when cultures remained negative after 72 hours. The patient was discharged after five days, with resolution of symptoms and fever.