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24 March 2021: Articles

“Double Trouble”: Severe Meningoencephalitis Due to and Powassan Virus Co-Infection Successfully Treated with Intravenous Immunoglobulin

Unusual or unexpected effect of treatment, Rare coexistence of disease or pathology

Igor Dumic A* , Bridget Glomski A , Janki Patel C , Terri Nordin E , Charles W. Nordstrom E , Lawrence J. Sprecher E , Eric Niendorf B , Amteshwar Singh D , Kosana Simeunovic A , Anand Subramanian C , Olandapo Igandan E , Danilo Vitorovic A

DOI: 10.12659/AJCR.929952

Am J Case Rep 2021; 22:e929952

Table 1. Summary of negative diagnostic tests that were done in our patient to rule out autoimmune, infectious, and paraneoplastic etiologies of encephalitis. Positive tests included: B. burgdorferi serum IgM and IgG, B. burgdorferi PCR in CSF (Mayo Medical Laboratories), and CSF IgM and plaque reduction neutralization test (PRNT) against POWV (CDC, Arboviral Disease Branch, Fort Collins, CO, USA).

Tests done on serumTests done on CSF
Ab and PCR Ab and PCR Ab Ab AgQuantiFERON TB GOLDRPRWest nile virus PCRCMV AbEBV AbHIV AbHBV AbHCV AbANARFSSA AbSSB AbHSV-1 PCRHSV-2 PCRVZV PCREBV PCRCMV PCREnterovirus PCR PCR 6 PCRAdenovirus PCR PCRSt. Louis Encephalitis IgM and IgG AbCalif (LaCrosse) Encephalitis Virus IgM and IgGWest Equine Encephalitis Virus IgM and IgG AbAnti-ANNA-1 (anti-Hu) AbAnti-ANNA-2 (anti-Ri) AbAnti-ANNA 3 AbAGNA (Sox 1) AbAmphiphysin Ab IgGAnti-PCI-1 Ab (anti-Yo) AbAnti-PCI-Tr AbAnti-PCI-2 AbAntibodies to Ta AbGAD-65 AbAnti-VGKC AbNMO AbAQP-4 Ab
Ag – antigen; AGNA – anti-glial/neuronal antibody; Ab – antibody; ANA – anti-nuclear antibody; ANNA – anti-neuronal nuclear antibody; AQP-4 – aquaporin-4; CMV – cytomegalovirus; EBV – Ebstein Barr virus; HBV – hepatitis B virus; HCV – hepatitis C virus; GAD – glutamic acid decarboxylase; HIV – human immunodeficiency virus; HSV – herpes simplex virus; NMO – neuromyelitis optica; PCR –polymerase chain reaction; RPR – rapid plasma regain; RF – Rheumatoid factor; SSA – anti-Sjogren’s syndrome A; SSB – anti-Sjogren’s syndrome B; VZV – Varicella zoster virus; VGKC – voltage gated potassium channel; PCA – Purkinje cell cytoplasmic antibody.

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923