Successful Treatment of Neuropathic Pain and Mood Symptoms with Duloxetine in a Patient with West Nile Virus Infection

Abstract

Neuropathic pain and concomitant mood disorder in West Nile Virus (WNV) infection seem difficult to control. A 57years old female diagnosed with neuroinvasive WNV infection presented with burning pain in the hands and feet consistent with neuropathic pain. In addition, a Patient Health Questionnaire-2 (PHQ-2) depression screening questionnaire administered to her was positive and on further interview she met diagnostic criteria for a mood disorder due to a general medical condition. Her symptoms included a loss of pleasure in all activities and mood lability. During her course of treatment, she also underwent five months of intensive physical therapy for rehabilitation and received intravenous immunoglobulin infusions for flaccid paralysis secondary to an inflammatory peripheral neuropathy attributed to WNV infection. The neuropathic pain and mood disorder dramatically disappeared after using duloxetine. Duloxetine is recommended for neuropathic pain management especially in patients with WNV infection.