"Fatal Neuroinvasive Jamestown Canyon Virus in an Immunocompetent Patie" by Usman Bin Hameed, Mujtaba Moazzam et al.
 

Fatal Neuroinvasive Jamestown Canyon Virus in an Immunocompetent Patient

Document Type

Conference Proceeding

Publication Date

5-2025

Publication Title

American Journal of Respiratory and Critical Care Medicine

Abstract

Jamestown Canyon Virus (JCV) neuroinvasive disease is a rare arboviral infection with fewer than 50 documented neuroinvasive cases in the United States. Typically, JCV infections present with mild symptoms, and neuroinvasive manifestations primarily occur in immunocompromised individuals, older males, or those with comorbidities. This report describes a unique case of neuroinvasive JCV in an immunocompetent 65-year-old female from Michigan, an endemic region, who developed progressive encephalitis, leading to fatal neurologic decline. A 65-year-old immunocompetent female presented with confusion, hallucinations, right-sided facial palsy, diplopia, ataxia, supraorbital pain, fever, and cognitive decline. She was initially treated empirically with broad-spectrum antimicrobials, including vancomycin, ceftriaxone, ampicillin, acyclovir, and fluconazole, for suspected infectious encephalitis. Neuroimaging showed progressive leptomeningeal thickening and enhancement in the temporal lobes, brainstem, and cranial nerves, while lumbar punctures revealed elevated protein, lymphocytic pleocytosis, and oligoclonal bands. Despite an extensive infectious and autoimmune workup, the cause remained elusive until a lumbar puncture confirmed JCV IgM antibodies, indicating neuroinvasive disease. The patient’s encephalopathy worsened despite supportive care, and her responsiveness declined, necessitating intubation for airway protection. A subsequent CT scan revealed a right temporal intracerebral hemorrhage, subdural hemorrhage, and midline shift, with neurosurgery deeming intervention too risky. Supportive measures, including hyperosmolar therapy and vasopressors, were initiated. Further neurological decline was noted, with fixed, dilated pupils and absent brainstem reflexes; imaging confirmed worsening hemorrhage and herniation. Care transitioned to comfort measures, and the patient passed away. Neuroinvasive JCV is exceptionally rare; severe neurological outcomes, such as encephalitis, are unusual with JCV, making this case’s progression notable. Imaging in this patient revealed progressive leptomeningeal thickening, nodular changes, and hemorrhagic complications features not commonly associated with JCV. Diagnosis of JCV often requires specialized testing not included in routine panels. Confirmatory testing, as seen in this patient, involves detection of JCV IgM antibodies in serum or CSF or plaque reduction neutralization testing. Despite early detection through an arboviral panel, the patient’s condition deteriorated despite extensive supportive care. Given the rarity of neuroinvasive JCV, targeted antiviral treatment remains unavailable, making supportive care the mainstay. This patient’s hemorrhagic complications underscore a possible, underexplored impact of JCV on CNS vascular integrity. This case illustrates the diagnostic and therapeutic challenges posed by JCV, emphasizing the need for further research to understand its full clinical spectrum and to develop potential management strategies, particularly as ecological changes may expand JCV’s range and impact.

Volume

211

First Page

A7845

Comments

American Thoracic Society (ATS) International Conference, May 16-21, 2025, San Francisco, CA

Last Page

A7845

DOI

10.1164/ajrccm.2025.211.Abstracts.A7845

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