A 58-year-old man with cardiovascular disease, chronic obstructive pulmonary disease, diabetes, chronic kidney disease, and psoriasis was taking ixekizumab and prednisone. He was bitten by a mosquito and a tick two weeks ago, and soon developed chest pain, shortness of breath, confusion, worsening weakness, nausea, vomiting, fever, and rash. Brain imaging was negative, initial infectious tests and lumbar puncture were negative, he received empiric antibiotic and antiviral therapy. After 11 days of hospitalization, the symptoms improved, he was discharged to supportive care. 6 days later the cerebrospinal fluid was positive for West Nile virus. This is the first case of meningoencephalitis caused by this virus in southwest Michigan. West Nile virus is the most common cause of mosquito-borne disease in the US, with neuroinvasive disease occurring in less than 1% of cases. The patient's immunosuppressive medications and comorbidities put him at higher risk.