Since its introduction in New York City in 1999, the virus has spread throughout the entire North American continent and continues to spread into Central and Latin America. Our report discusses the signs and symptoms, diagnostics, and treatment of West Nile disease. It is important to recognize the disease quickly and initiate appropriate treatment. We present three cases of West Nile encephalitis at White Memorial Medical Center in East Los Angeles that occurred over the span of eight days. All three patients live within four to six miles from the hospital and do not live or work in an environment favorable to mosquitoes including shallow bodies of standing water, abandoned tires, or mud ruts. All the patients were Hispanic. Physicians and other health care providers should consider West Nile infection in the differential diagnosis of causes of aseptic meningitis and encephalitis, obtain appropriate laboratory studies, and promptly report cases to public health authorities. State governments should establish abatement programs that will eliminate sources that allow for mosquito reproduction and harboring. The public needs to be given resources that educate them on what entails the disease caused by the West Nile virus, what the symptoms are, and, most importantly, what they can do to prevent themselves from becoming infected.
We present a case of serologically proved West Nile encephalitis. This patient had a normal MRI on admission. Given that the patient's clinical picture had worsened during her admission, a repeat MRI was performed, which demonstrated diffuse disease in the deep white matter of the brain. This is a case of West Nice encephalitis presenting as a disease of deep white matter that developed over a two-week span.
SummaryRadioiodine (131I) is a critical component in the treatment of differentiated thyroid cancer. We recently saw a patient with thyroid cancer who was hesitant to take 131I treatment because he had previously encountered an allergic reaction to administration of iodine-containing radiocontrast agent for computed tomography (CT) scanning. We were able to administer 131I treatment after discussion that his anaphylactic reaction was not due to iodine and that radioiodine (131I) treatment is unlikely to cause a reaction in the patient.Learning points
An allergy to iodine itself does not exist.When patients claim that they have an ‘iodine allergy’, ask them what substances they are allergic to and what kind of reaction occurred during use of such substances.Radioactive iodine is not a contraindication for patients who claim an ‘allergy to iodine’.
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