f Cache Valley virus was initially isolated from mosquitoes and had been linked to central nervous system-associated diseases. A case of Cache Valley virus infection is described. The virus was cultured from a patient's cerebrospinal fluid and identified with real-time reverse transcription-PCR and sequencing, which also yielded the complete viral coding sequences.
CASE REPORT
In mid-September 2011, a 63-year-old woman presented to an upstate New York hospital with complaints of fever, headache, neck stiffness, and photophobia. One week earlier, she had noticed a macular, nonpruritic lesion on her right forearm, about 3 cm in diameter, with central clearing. Three days prior, as the first lesion was fading, a petechial rash developed on her lower extremities that spread to her torso. She then traveled to Pennsylvania for a weekend, and during this time she developed the mentioned fever and symptoms of meningitis. She returned home and went to the Emergency Department (ED) of the hospital the next morning.On physical examination, the patient appeared alert and oriented, with a blood pressure of 148-mm/80-mm Hg, a pulse rate of 87 per min, a respiratory rate of 18 per min, an oral temperature of 37.6°C, and an oxygen saturation of 99% on room air. She had a scattered, bilateral, petechial rash on her thighs; meanwhile, the lesions on her back and abdomen were fading. She had moderate neck stiffness. Her neurologic exam was otherwise normal; there was no evidence of encephalitis, cranial nerve abnormalities, or focal findings.Her medical record included a history of hypertension, hypothyroidism, meningioma, and migraine headaches and of rheumatic fever during childhood. The patient stated that she and her husband frequently camped outdoors. Throughout mid-to late August they camped in Wyoming and Livingston counties in New York state and also embarked on a 5-day camping trip in Dansville, NY, through Vermont and New Hampshire. She lived with her husband, had a cat, and frequently tended to her garden around her home. She had no knowledge of any sick contact.Her white blood cell count on presentation was 5,700/l, with a normal differential. Hematocrit was normal at 42%, and platelets were normal at 212,000/l. Computed tomography of the head without contrast showed mild atrophy without evidence of acute intracranial abnormality. Blood cultures were drawn, and she was sent home on doxycycline. The patient returned to the ED the following day with new complaints of nausea and vomiting in addition to the previously reported symptoms.The patient was admitted to the hospital with a preliminary diagnosis of aseptic meningitis. A lumbar puncture was performed, and the cerebrospinal fluid (CSF) showed 216 nucleated cells, with 91% lymphocytes, 7% monocytes, 1% basophils, and 1% polymorphonuclear cells. CSF chemistries were normal, with a glucose concentration of 60 mg/dl (56% of the serum level) and protein of 46 mg/dl. No microorganism was seen in the CSF by Gram stain. Magnetic resonance imaging of the brain showed only a ...
