Infectious Disease · 3 h ago
Fatal Powassan Virus Infection Involved Multiple Organs in a Liver Transplant Recipient
A case report describes fatal Powassan virus lineage 2 infection in a 38-year-old woman six weeks after liver transplantation. Postmortem testing identified viral antigen or RNA in brain, lung and kidney tissues, indicating infection beyond the central nervous system.
- POWV lineage 2 was confirmed shortly before the patient's death.
- Postmortem testing detected virus in brain, lung and kidney.
- The single case cannot establish frequency or typical disease course.
Powassan virus (POWV) is a tickborne flavivirus that can cause severe encephalitis. This report describes a 38-year-old liver transplant recipient in Pennsylvania who developed fever, headache and seizures six weeks after transplantation. Cerebrospinal fluid testing identified POWV lineage 2 shortly before her death; investigators considered tick exposure the most likely route, though no bite was documented.
Autopsy showed widespread meningoencephalitis, brain edema and necrosis. Immunohistochemistry, in situ hybridization or reverse transcription PCR detected POWV in postmortem brain, lung and kidney samples. Findings included viral antigen and RNA in bronchiolar epithelial cells, as well as renal tubular necrosis and peritubular inflammation. Testing of the donor liver at transplantation was negative for POWV.
The findings suggest that disseminated POWV infection can involve organs outside the central nervous system in an immunosuppressed transplant recipient. This single fatal case cannot establish how often such dissemination occurs or prove that direct viral infection caused all organ injury. The authors note that early-release articles may be revised before final publication.
In practice
This case shows that severe Powassan virus infection in an immunosuppressed transplant recipient may extend beyond the central nervous system: viral antigen or RNA was detected in postmortem lung and kidney as well as brain tissue. It may broaden the differential when a transplant recipient has compatible encephalitis and multisystem injury, but one fatal case does not establish how frequently dissemination occurs, how to identify it reliably, or whether a different diagnostic or treatment approach improves outcomes. The report does not support a change in management.
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Emerging Infectious Diseases: Fatal Disseminated Powassan Virus Infection in Transplant Recipient, Pennsylvania, USA ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.