Carolinas Research Day 2021

Clinical Case-Based Studies

13 Autoimmune Encephalopathy

Michaeleena Carr, DO, Joseph Filek, OMSIV

Edward Via College of Osteopathic Medicine-Carolinas, Prisma Health

Introduction: Autoimmune encephalopathy is a rare and relatively novel disease in the world of neurology with an incidence rate of only 0.8/100,000 people. It was once a diagnosis based on exclusion of other diseases, but with the discovery of new autoantibodies such as α-amino-3-hydroxy-5-methyl- 4-isoxazolepropionic acid, N-methyl-D-aspartate receptor, Leucine-rich, glioma-inactivated 1, and anti- neuronal nuclear antibody 1, it is starting to become more easily recognized. It is thought that many previous idiopathic causes of altered mental statuses may be a result of autoimmune encephalopathy. It typically presents itself as a subacute deficit in memory and cognition with associated psychosis, and many types have associations with malignancies. This case report discusses a 42-year-old female who presented to the emergency department for bizarre behavior on several occasions. She was reported as being very combative when touched and noncooperative to commands. The patient was transferred and held in the psychiatric unit where

she experienced frequent delusions, hyperreligiosity, auditory hallucinations, and aggressive outbursts that were both verbal and physical. Following multiple psychiatric and neurologic evaluations, anti-nuclear and sjogren antibodies were discovered. At this point, her diagnosis shifted to a possible case of an autoimmune derived illness rather than being psychiatric in origin. After three weeks of no improvement, the patient was transferred to a medical unit for empirical treatment with methylprednisolone 1g IV daily for 5 days and was being followed by neurology. Patient was suspected of autoimmune encephalitis. Presently, the patient is still being closely monitored. The prognosis of this illness is based on the classification of the disease, as some types may be fully reversible while others result in irreversible damage and thus a poorer prognosis. Intracellular types of autoimmune encephalopathy tend to be more associated with cancer, paraneoplastic syndromes, and T-cell responses against neurons. On the other

hand, the extracellular class tends to be more loosely associated with cancer and as a result, a less severe prognosis. Therefore, it is imperative to continue to research this disease, hasten diagnosis in the clinical setting, and eventually lead to a better prognosis and overall care of patients. It is also important to be mindful of the osteopathic approach when caring for patients. This patient presented to the emergency department on several occasions without mention of family medicine intervention. If the patient had a strong relationship with her family medicine physician, it may have been discovered sooner that she did not have a past medical history of psychiatric disorders and thus proper treatment could have initiated sooner. As a result, it is not only vital to strengthen the doctor- patient relationship through mind, body, and spiritual bonds, but it also shows the importance of the role of family medicine in patient care.

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