Opsoclonus-Myoclonus-Ataxia Syndrome in a Patient With West Nile Virus: Case Report and a Patient's Experience.

Abstract

Opsoclonus-myoclonus-ataxia syndrome (OMAS) is a rare neurological condition most often diagnosed as a paraneoplastic or parainfectious syndrome. There have been some reports of OMAS in association with West Nile virus (WNV) in the literature, but both treatment and outcomes have been variable. Furthermore, some evidence suggests that patients who are treated earlier in the disease course have better outcomes, both in terms of time to disease remission and long-term symptom relief. Here, we present the case of a healthy 26-year-old patient who suddenly developed tremulousness and weakness of the lower extremities which progressively worsened over the course of 5 days; during this time, the patient developed nausea, gait unsteadiness, and rapid uncontrollable eye movements, leading to his hospital presentation. On hospital day two, the patient was diagnosed with OMAS due to exam findings of rapid, conjugate, saccadic bursts and myoclonic muscle activity, with serum and cerebrospinal fluid studies positive for WNV. Treatment with intravenous steroids and immunoglobulin began immediately afterwards and resulted in rapid improvement by the time of discharge 7 days after treatment was initiated. This case demonstrates the importance of developing broad differential diagnoses for uncommon disease presentations and the importance of treatment timeliness for better outcomes of OMAS. Furthermore, this report shows the need for more systematic studies on OMAS treatment and outcomes, as the current literature is somewhat limited due to the sporadic nature of the disease. Lastly, we highlight the patient's own heartfelt narrative of this illness and his experiences with recovery.