Unveiling the Unforeseen
Abstract
- This Clinical Problem-Solving case report recounts the diagnostic journey of a 57-year-old woman who developed encephalopathy and progressive neurological deterioration following kidney and pancreas transplantation. Despite negative early imaging and broad-spectrum empiric treatment, cerebrospinal fluid (CSF) testing ultimately confirmed Powassan virus lineage II infection a rare tickborne arbovirus endemic to the upper Midwest. MRI later revealed cerebellitis, thalamic involvement, and spinal myelitis. The patient received supportive care, including immune globulin and reduced immunosuppression. Though organ grafts functioned well, her neurological recovery was limited. The case underscores the importance of high clinical suspicion, PCR-based testing in immunocompromised patients, and consideration of arboviral encephalitis even in colder seasons amid changing tick ecology
Keywords:
encephalitis
Powassan virus
immunosuppression
post-transplant infection
rhombencephalitis
PCR diagnostics
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