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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