GABAA receptor encephalitis associated with human parvovirus B19 virus infection: Case report

Autor: Carolina Prando, Daniel Almeida do Valle, Mônica J Spinosa, Mara Lúcia Schmitz Ferreira Santos, Bruno Augusto Telles, Mara L. Cordeiro
Rok vydání: 2021
Předmět:
Male
encephalitis
Azathioprine
Parvovirus B19
Neurodegenerative
0302 clinical medicine
Status Epilepticus
gamma-aminobutyric acid type A receptor antagonists
Receptors
Parvovirus B19
Human
2.1 Biological and endogenous factors
030212 general & internal medicine
Aetiology
human parvovirus B19
Child
Cerebrospinal Fluid
General Medicine
Plasmapheresis
Treatment Outcome
Methylprednisolone
030220 oncology & carcinogenesis
Neurological
Prednisolone
Cyclosporine
medicine.symptom
Encephalitis
Immunosuppressive Agents
Human
medicine.drug
Research Article
Diagnostic Techniques
Neurological
Status epilepticus
Autoimmune Disease
Antibodies
Parvoviridae Infections
03 medical and health sciences
medicine
Humans
Clinical Case Report
Pleocytosis
Autoimmune disease
Autoimmune encephalitis
Epilepsy
GABA-A
business.industry
Neurosciences
γ-aminobutyric acid type A receptor antagonists
medicine.disease
Receptors
GABA-A
Brain Disorders
Diagnostic Techniques
Immunology
business
Zdroj: Medicine
Medicine, vol 100, iss 23
ISSN: 1536-5964
Popis: Rationale: Human parvovirus B19 (B19) infection can produce a spectrum of clinical syndromes, including neurological manifestations, most notably encephalitis. Although symptoms suggestive of autoimmune disease in patients with B19 infection have been previously described, a clear association of autoimmune encephalitis with B19 infection has yet to be established. Patient concerns: We describe the case of a 6-year-old boy who was hospitalized due to status epilepticus, which evolved to super-refractory status epilepticus that was only mildly responsive to anticonvulsant drugs. Diagnosis: A cerebrospinal fluid study identified slight pleocytosis and B19 positivity. A subsequent autoimmunity cerebrospinal fluid study revealed the presence of anti-γ-aminobutyric acid type A (GABAA) receptor antibodies. Interventions: After pulse therapy with methylprednisolone and continuous therapy with prednisolone with cyclosporine, the patient experiencing seizure persistence with disordered motor function manifestations and only minor improvement in consciousness, and so, plasmapheresis was performed. With continued immunosuppressive treatments with cyclosporine and prednisolone, the patient's clinical picture showed progressive improvement, with good control of seizures. Although the patient tolerated withdrawal of the anticonvulsant drugs well, he developed seizures when corticosteroid therapy withdrawal was attempted, so was started on azathioprine. Outcomes: After immunosuppressive therapy, the patient evolved with complete remission of symptoms, normal neurological examination and age-appropriate neuropsychomotor development. Lessons: The present case characteristics, together with previous findings, support the hypothesis that autoimmunity may be triggered by extensive antigen release due to degeneration of infected neurons. This case highlights the importance of early clinical suspicion and treatment.
Databáze: OpenAIRE
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