CHSU Discovery

Abstract: 

Purpose of Study: The patient, a previously healthy 32-year-old female, initially presented with psychiatric symptoms, including psychosis, agitation, and delusions. Subsequent neurological examination revealed the presence of seizures, abnormal movements, and autonomic dysfunction. Seronegative autoimmune encephalitis was diagnosed after a thorough diagnostic workup, including cerebrospinal fluid analysis and antibody testing. The patient received prompt immunotherapy, including corticosteroids and intravenous immunoglobulin. However, antibodies were negative in the serum and CSF. Additionally, tumor screening was negative. Over the course of several weeks, the patient showed significant improvement in both neurological and psychiatric symptoms. This case report highlights the importance of early recognition and treatment of seronegative autoimmune encephalitis. By sharing this case, we aim to contribute to the knowledge of autoimmune encephalitis and enhance awareness for timely diagnosis and appropriate management of this challenging and complex condition. 

Methods: A comprehensive evaluation of the patient's medical history, physical assessments, laboratory investigations, and neuroimaging studies was conducted. Diagnostic procedures included cerebrospinal fluid analysis, evaluation of serum antibody levels, electroencephalogram recordings, and brain magnetic resonance imaging. 

Results: Following a thorough investigation and exclusion of other potential causes, a diagnosis of autoimmune encephalitis was established. There was no detection of specific antibodies in the serum or cerebrospinal fluid. Brain MRI was negative, and EEG was abnormal - consistent with encephalitis. Despite the absence of detectable antibodies in the CSF, the patient's clinical presentation and EEG findings suggested an autoimmune etiology. Empirical immunotherapy was initiated, consisting of corticosteroids and intravenous immunoglobulin (IVIG). Supportive care and close monitoring of symptoms, vital signs, and neurological status were also provided. Remarkably, the patient demonstrated significant improvement in cognitive function and neurological deficits within weeks of treatment initiation, further supporting our evidence of autoimmune encephalitis.

Conclusion: Following the initiation of treatment, the patient exhibited improvement in psychiatric symptoms, resolution of seizures, and a return to baseline neurological functioning. This case highlights the importance of considering seronegative autoimmune encephalitis in patients with suggestive clinical features, even without detectable antibodies in the CSF. Negative CSF antibodies should not exclude the possibility of an autoimmune etiology, as the diagnostic sensitivity of current antibody panels is not absolute. This case further emphasizes the significance of early recognition and prompt treatment in effectively managing seronegative autoimmune encephalitis.