Anti-GABAB Receptor Autoimmune Encephalitis: A Report of a Rare Case in Central America.
| Autor: | Santos AB; Faculty of Medicine, University of Costa Rica, San José, CRI., Hong A; Faculty of Medicine, University of Costa Rica, San José, CRI., Hong I; Faculty of Medicine, University of Costa Rica, San José, CRI., Villegas JD; Department of Neurology, Hospital San Juan de Dios, San José, CRI. |
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| Jazyk: | angličtina |
| Zdroj: | Cureus [Cureus] 2024 Aug 29; Vol. 16 (8), pp. e68111. Date of Electronic Publication: 2024 Aug 29 (Print Publication: 2024). |
| DOI: | 10.7759/cureus.68111 |
| Abstrakt: | Autoimmune encephalitis (AE) is a rare disease. There have been very few reports of anti-GABAB receptor encephalitis, and no case of this subtype has ever been reported in Central America. We present a case of a 21-year-old male patient with an unremarkable previous medical history who was hospitalized because of a new onset of seizures and status epilepticus. Central nervous system infections, neoplastic disorders, cerebrovascular disease, septic and metabolic encephalopathy, and drug toxicity were ruled out. Cerebrospinal fluid (CSF) revealed lymphocytic pleocytosis and oligoclonal bands. Initial head computed tomography (CT) scans with and without contrast were normal, and brain magnetic resonance imaging (MRI) showed no abnormalities. An electroencephalogram showed slow waves and spike waves in the frontal and temporal areas. During hospitalization, encephalopathy progressed, along with seizures and altered mental status requiring mechanical ventilation and admission to the intensive care unit. Intravenous valproic acid and phenytoin for seizure control were given. The unexplained seizures, persisting altered mental status despite the reduction of sedatives, CSF pleocytosis, and oligoclonal bands, along with reasonable exclusion of alternative disorders, suggested AE. The diagnosis was confirmed with positive anti-GABAB1-B2 receptor antibody titers in serum and CSF. A whole-body CT scan showed increased pancreatic head size, but endoscopic ultrasonography ruled out malignancy, and a normal IgG4 range excluded IgG4 disease. The patient received treatment with methylprednisolone, plasmapheresis, and immunoglobulin therapy, with excellent response. The patient has been followed up for seven months, taking immunomodulation with mycophenolate. He is seizure-free with valproic acid and levetiracetam treatment and is receiving cognitive rehabilitation after mild cognitive decline was noted in the psychometric analysis. Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. (Copyright © 2024, Santos et al.) |
| Databáze: | MEDLINE |
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