Abstract: FR-PO784
Donor-Derived West Nile Virus Infection After Renal Transplant Treated with Plasmapheresis
Session Information
- Post-Transplantation and Case Reports
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Bukhari, Syeda Sadia, SUNY Downstate Health Sciences University, New York City, New York, United States
- Basa, Adrianne Franche, NYU Langone Health, New York, New York, United States
- Elhawary, Omar Nabil, SUNY Downstate Health Sciences University, New York City, New York, United States
- Sasidharan, Sandeep Raja, SUNY Downstate Health Sciences University, New York City, New York, United States
- Salifu, Moro O., SUNY Downstate Health Sciences University, New York City, New York, United States
- Saggi, Subodh J., SUNY Downstate Health Sciences University, New York City, New York, United States
Introduction
West Nile Virus is a single-stranded RNA Flavivirus usually transmitted through mosquito bites. The clinical presentation usually varies from asymptomatic, mild gastrointestinal symptoms and fever to <1% developing Neuroinvasive disease. The literature showed that organ derived WNV infection is associated with 70% of neurological sequelae and 30% of severe morbidity and mortality. The onset of symptomatic WNV infection post-organ transplant is usually around 13 days however the range varies from 5-37 days.
Case Description
A 50 Y/O male who presented for a Deceased Donor kidney transplant. His previous history included ESRD on Peritoneal dialysis, Focal segmental Glomerulosclerosis, and Hypertension. He denies any sick contacts and recent travel. His review of systems and physical examination were normal.
He developed fever, altered sensorium and seizures almost 16 days post-transplant. On neurological examination, he was found to be minimally responsive. Initial work including CSF fluid analysis and a CT scan of the Brain was inconclusive. His MRI showed linear symmetric restricted diffusion in both cerebellar hemispheres and his post-transplant Ct scan showed a colonic mass.
The patient was given two sessions of plasmapheresis based on the pertinent MRI findings and suspicion of paraneoplastic syndrome. His lab reported later showed negative paraneoplastic panel. The primary team sent the WNV panel to the Department of Health and it came back positive for WNV IgM. His serum and urine PCR also came back positive for WNV antigen.
Plasmapheresis was stopped and IVIG was started based on some previous case reports. Additional two sessions of plasmapheresis were given post-IVIG, and his blood and urine turned negative for WNV IgM after 14 days of treatment. Repeated MRI also showed stable restriction diffusion defects.
Discussion
The treatment for WNV is usually supportive, reduction of immunosuppressants and IVIG. Some case reports show additional benefits of plasmapheresis especially in neuroinvasive disease. So far only IVIG has been used and showed benefits in West Nile Virus Infection after solid organ transplant. This was the first-time plasmapheresis was done and showed a significant response. WNV screening should be considered a routine workup for potential organ donors living in endemic areas.