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Abstract Details

Powassan Virus: A Diverse Appearing Encephalitis
Infectious Disease
P10 - Poster Session 10 (5:30 PM-6:30 PM)
13-006
Here we report on a case of a 62 year old male with CLL who presents with altered mental status over a 1 week period. During his hospitalization, he had broad infectious and autoimmune work-up but developed significant leukocytosis and with a CSF pleocytosis. cEEG monitoring revealed unilateral LRDA which was followed by initial MRI showing unilateral messiah temporal FLAIR hyper intensity. Given significant leukocytosis without clear common infectious etiology, main differential diagnosis for the patient included CNS involvement of systemic CLL, autoimmune / paraneoplastic encephalitis or rare viral infectious encephalitis. There was weak history of recent tick bite with minimal attachment time, but systemic Lyme Western Blot was negative. Despite treatment with high dose IV steroids, MRI evolved to cerebellitis at which point IVIG was given. Patient then had slow improvement in mental status despite third MRI Brain showing FLAIR hyperintensity in the bilateral globus pallidi, bilateral cerebral peduncles, and bilateral dentate nuclei. At that time, CDC testing returned positive for high titers of Powassan virus IgM, indicating presentation consistent with Powassan Encephalitis. This case represents an interesting progression of imaging in a clear clinical encephalitis case that is not altogether typical for Powassan Encephalitis. Additionally, it brings to light consideration of the role of CLL in disease course given the effects of CLL on immunocompetence in a viral process in which CNS pathology is typically immune-mediated. The patient was able to be discharged from the hospital and with skilled rehabilitation regained some physical ability but is left with clear cerebellar mutism. 
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Authors/Disclosures
Christopher B. Traner, MD
PRESENTER 		Dr. Traner has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Neuropace. Dr. Traner has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Ceribell Inc. Dr. Traner has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for National Resident Matching Program .
Firas Kaddouh, MD Dr. Kaddouh has nothing to disclose.
Guido J. Falcone, MD (Yale School of Medicine) The institution of Dr. Falcone has received research support from NIH. The institution of Dr. Falcone has received research support from AHA.