Emerging Threat: First Case of West Nile Virus Encephalitis in Peshawar, Pakistan

West Nile Virus (WNV), once confined primarily to Africa, is now an emerging communicable disease in Pakistan. Clinical cases and serological evidence of WNV infection have been documented in both human and animal populations in the Punjab and Sindh provinces of Pakistan. We report the first case of WNV encephalitis in an 80-year-old hypertensive and diabetic lady from district Peshawar. Sadly, the patient did not survive. This case highlights the importance of thinking of zebras in addition to horses when confronted with the sound of hoofbeats, as ‘zebra diagnoses’ do exist. Clinicians shall consider novel infections when evaluating patients with fever and altered mental status.