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Background West Nile virus was first documented in 1937. Nearly 50% of cases have Neuro-invasive pathology and a significant number of deaths, indeed a hefty disease burden. Climate change is believed to play a role in recent epidemics.This is a case of a 68-year-old lady previously fit and well, visiting the UK from Israel, presented to hospital with subacute vomiting and asymmetric flaccid paraparesis, mimicking GBS. As certain features were deemed atypical features for GBS and considering the travel history. It was decided to proceed with an out of hours MRI spine urgently prior to administering IVIG. Despite that she was non-ambulant. MRI spine showed short segment high T2/STIR signal T10>T12/L1 + possible mild swelling. CSF showed WBCs158 predominantly lymphocytes, and protein 1.08, West Nile IgM was positive in CSF.Main differential, infective myelitis. She rapidly deteriorated, became drowsy and confused, with dysphagia, and was transferred to ITU, requiring respiratory support. Flown back home as an overseas ITU to ITU transfer, currently long-term paraparesis not fully recovered, lost independence in mobility. Cognitively intact, emotionally destroyed.Discussion Although the treatment for WNV is non-specific and mainly supportive. It remains crucial to make the diagnosis of west Nile virus, typically manifesting with asymmetric paraparesis, fevers and encephalitis. Management was determined based on the various causes of infective encephalomyelitis, safety of steroids and IVIG, avoiding plasma exchange. Vaccine will be the solution.amy.eskander@nhs.net