Case & Review
Punctate exanthem of West Nile Virus infection: Report of 3 cases

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The West Nile Virus (WNV) has rapidly emerged as an important etiology of meningoencephalitis in North America since 1999. Diagnosis of this infection on clinical grounds is difficult, as many signs and symptoms of infection are nonspecific. Although cutaneous manifestations are common in WNV-infected patients, these have not been described in detail nor are clinical images widely available. We describe 3 patients with WNV infections, two ambulatory, one hospitalized, who developed punctate erythematous, macular, and papular eruptions, most pronounced on the extremities. Histopathologic findings in one case showed a sparse superficial perivascular lymphocytic infiltrate, a feature commonly seen in viral exanthems but not previously reported with WNV infection. A literature review provides support that this punctate exanthem is a common cutaneous presentation of WNV infection.

Section snippets

Case 1

A 40-year-old female was seen as an outpatient with a 1-week history of lethargy, and a 5-day history of an asymptomatic “rash” on the bilateral arms, legs, and trunk (Fig 1, A and B). The patient developed her illness in August and lived in the Chicago area. There was no reported history of mosquito exposure. The patient had previously been seen by a primary care physician who had diagnosed her with folliculitis. Physical examination showed numerous 1 mm-2 mm erythematous blanchable papules on

Discussion

With numerous nonspecific signs and symptoms and a wide spectrum of clinical severity, diagnosis of WNL infection is often difficult, ultimately requiring serological confirmation. Thus, any clinical clues available to trigger appropriate diagnostic testing are valuable to the treating physician. Skin manifestations of WNV infection are common and are readily apparent to both patients and practitioners alike. Here we attempt to refine the characteristics of the eruption associated with WNV

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    Funding sources: None.

    Conflicts of interest: None identified.

    Reprints not available from the authors.

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