Establishing Potosi Virus as a Human Pathogen: Fatal Neuroinvasive Disease in a B-Cell-Depleted Patient.
Justin R Abbatemarco, Feroza Begum, Julian A Villalba et al.
✦ AI-curated · Sources linked
Case in brief
A 37-year-old woman with multiple sclerosis receiving long-term rituximab developed rapidly progressive dementia. MRI showed progressive generalized atrophy, while cerebrospinal fluid had only transient, minimal lymphocytic pleocytosis. Extensive infectious, autoimmune, and prion investigations were unrevealing; CSF metagenomic sequencing detected all three Potosi virus genome segments. Postmortem examination showed diffuse meningoencephalitis, and molecular, immunohistochemical, ultrastructural, and brain-tissue sequencing findings supported widespread Potosi virus infection. The convergent evidence established Potosi virus as the cause of fatal neuroinvasive disease in this patient.
What made this case unusual
The case links Potosi virus to fatal human neuroinvasive disease, with confirmation across CSF and brain-tissue sequencing, neuropathology, immunohistochemistry, and electron microscopy despite minimal conventional CSF inflammatory findings.
Diagnostic / clinical pearl
In immunocompromised patients with unexplained progressive neurologic decline, severe viral CNS disease may occur without prominent CSF inflammation; CSF metagenomic sequencing can help identify an otherwise undetected pathogen.