West Nile fever is a mosquito-borne febrile illness seen in Africa, Asia, and Europe, but reported in North America only once. The recent outbreak in New York City represents the first time this virus has been detected in North America. West Nile virus usually causes mild symptoms, though rarely it can cause neurologic diseases, with a fatal outcome or permanent neurologic sequelae. We describe an elderly patient with West Nile virus infection who presented with Guillain-Barré syndrome.