No abstract

West Nile Virus is one of the most frequently reported etiologies of viral encephalitis in the USA. West Nile Virus infections among hospitalized patients manifests most commonly as neuro-invasive disease. West Nile Virus has also been reported to cause myocarditis. Arrhythmia is not an uncommon occurrence in viral myocarditis. As cases of West Nile Virus increase, it is important that the index of suspicion also increase for this uncommon complication. Physicians who are caring for West Nile Virus-infected patients need to be aware of the possibility of West Nile Virus -related myocarditis. The question arises whether a patient with an established diagnosis of West Nile Virus -meningoencephalitis should be under continuous cardiac monitoring, bearing in mind the rare, but fatal, complication of cardiac arrhythmia secondary to viral myocarditis. We present a case report of a 65-year-old man who initially presented with fever, blurry vision, and decreased oral intake who subsequently suffered a fatal arrhythmia; further laboratory tests and autopsy findings revealed the patient likely had developed encephalitis and myocarditis secondary to West Nile Virus infection.

Pacemaker lead dislodgement can be defined as any lead position change, whether the functionality of the pacemaker is affected or not. Only dislodgements that provoke a malfunction in the pacing system, however, are clinically relevant. Lead dislodgement can be categorized as 'macro' or 'micro' dislodgement depending upon the presence of radiographic evidence. This case illustrates a case of lead microdislodgement after a low-impact motor vehicle accident. The lead tip was minimally displaced; enough to produce an increase in capture threshold and eventually loss of capture while keeping near normal lead impedance values. Review of the literature shows that ventricular lead dislodgement after a motor vehicle accident is a rare incidence and cause of pacemaker malfunction.