West Nile virus (WNV) infection should be considered in patients who present with psoriasiform eruption accompanied by fever and neurologic abnormalities, according to poster data presented at the recent 2014 American Academy of Dermatology Annual Meeting.

Robyn Marszalek, MD, Boston Medical Center Department of Dermatology, presented a poster detailing a 56-year-old man with an atypical presentation of WNV infection. He was admitted to the intensive care unit after he presented with fever, weakness, respiratory failure and altered mental status.

Upon admission, the patient developed acute ill-defined pseudovesicular erythematous papules on the palms of his hands, in addition to demarcated pink scaly psoriasiform papules and plaques on his feet and thighs.

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Although the cutaneous manifestations of WNV have not been well documented in the literature, viral exanthem was suspected clinically, and WNV PCR from the cerebrospinal fluid returned with a positive result, according to Marszalek.

“In the appropriate clinical setting, physicians should consider WNV in the differential diagnosis of patients presenting with fever, neurologic abnormalities, and new or flaring psoriasiform eruption,” Marszalek wrote.

Symptoms that resemble folliculitis, including transient, asymptomatic, punctate morbilliform macules and papules have been described in previous cases of WNV infection. However, they have been described as most frequently appearing on the extremities and trunk, and less frequently plantar petechiae and facial paralysis.


  1. Marszalek R. Abstract #P8346. Presented at: AAD 2014; March 21-25, 2014; Denver.


Disclosure: The researchers report no relevant financial disclosures.