Postencephalitic syndrome with immune-mediated psychosis in an adult with meningitis due to Streptococcus pneumoniae : A case report.

Autor:	Briceno B; Resident physician in the Psychiatry Department. Universidad del Rosario, Bogotá, Colombia.; MSc in Epidemiology. Universidad CES, Medellín, Colombia., Ariza-Varon M; Clinical Neurologist. Hospital Universitario Mayor - Méderi, Bogotá, Colombia.; Clinical Neurologist. Universidad Nacional de Colombia, Bogotá, Colombia.; MSc in Tropical Neurology and Infectious Diseases. Universitat Internacional de Catalunya, Catalunya, Spain., Pinzon N; Resident physician in the Neurology Department. Universidad del Rosario, Bogotá, Colombia.; MSc in Epidemiology. Universidad CES, Medellín, Colombia., Castro-Sepulveda JS; Inpatient physician. Hospital Universitario Mayor - Méderi, Bogotá, Colombia.; MSc in Clinical Epidemiology and Public Health. Universidad Internacional de Valencia, Valencia, Spain., Oviedo L; Research Coordinator. Neurology Unit. Hospital Universitario Mayor - Méderi, Bogotá, Colombia.
Jazyk:	angličtina
Zdroj:	IDCases [IDCases] 2024 Jul 31; Vol. 37, pp. e02041. Date of Electronic Publication: 2024 Jul 31 (Print Publication: 2024).
DOI:	10.1016/j.idcr.2024.e02041
Abstrakt:	Introduction: A first psychotic episode may be related to neurological diseases, especially encephalitis of infectious or autoimmune origin. It is remarkable that an immune-mediated encephalitis triggered by a confirmed subacute bacterial meningitis is documented, and this is the case we will present. Clinical Case: A 22-year-old woman with no previous medical history, immunocompetent, with three months of behavioral, affective and cognitive symptoms with subsequent compromise of sensory perception and psychosis. Examination of cerebrospinal fluid showed inflammatory signs with positive FilmArray© for Streptococcus pneumoniae. She received anti-psychotic and antibiotic treatment for 2 weeks without clinical improvement. Postencephalitic syndrome with immune-mediated psychosis was considered as a diagnosis, and immunosuppressive management with corticosteroid and plasmapheresis was initiated with complete resolution of symptoms. After one year of follow-up no neurological relapse has been identified. Discussion: Encephalitis is a neurological syndrome due to brain parenchymal damage that can result in psychiatric symptoms including psychosis and behavioral changes. Its causes are usually infectious (usually viral) or autoimmune (Anti NMDA, AMPA, LGI1 or others). A psychiatric condition in bacterial meningitis without improvement with antibiotic treatment is remarkable, its presence should suggest an immune-mediated post-infectious syndrome that may respond to the use of immunomodulators even in the absence of identification of autoimmune encephalitis-associated antibodies. No similar cases have been reported in the literature. Conclusion: Immune-mediated psychosis may be a manifestation of post-encephalitic syndrome associated with bacterial meningitis and its treatment with immunosuppressants may offer benefit in cases where the use of antipsychotics and antibiotics shows no improvement. Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. (© 2024 Published by Elsevier Ltd.)
Databáze:	MEDLINE
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