Purpose: To describe a case of seronegative West Nile virus (WNV) meningoencephalitis definitively diagnosed with ophthalmologic examination and confirmatory repeat laboratory testing.
Design: Diagnostic case report.
Methods: A patient with negative serologic testing for severe viral meningoencephalitis presented with photophobia and blurred vision 2 months after initial presentation.
Results: Examination revealed all the classic ocular findings of WNV. Repeat serologic testing confirmed positive titers for WNV.
Conclusions: WNV may initially present as a severe meningoencephalitis with negative serology. Ophthalmic examination, particularly in symptomatic patients, may help with diagnosis. The ophthalmologist may play a critical role in evaluation of possible WNV meningoencephalitis.