252 West Nile Virus presenting as a bullous dermatosis with evidence for keratinocyte involvement in viral replication

West Nile Virus (WNV) is a leading cause of viral encephalitis in the United States. Infected mosquitos deliver virus to skin before moves draining lymph nodes establish systemic infection. In vitro studies human keratinocytes and vivo mice suggest role for replication, rashes have been reported half WNV patients, but early stages infection patients remain incompletely understood. We report 58-year-old male patient who presented with altered mental status, rigors, fever, rash. A morbilliform eruption on back abdomen evolved into vesicular eruption. Pathology revealed an intraepidermal vesicle acantholysis consistent Grover disease. was diagnosed by presence IgM antibodies serum cerebrospinal fluid. Immunohistochemistry (IHC) excluded herpes simplex varicella zoster infection, direct immunofluorescence (IF) autoimmune blistering diseases. Followup abundant non-structural glycoprotein 1 (NS1) IF IHC. The recovered fully supportive care. This case reveals be present lesions suggests that support replication. should included as rare eruptions.