Abstract Details

Title A Rare Case of Cerebral Tuberculosis and Autoimmune Encephalitis

Topic Autoimmune Neurology

Presentation(s) P3 - Poster Session 3 (12:00 PM-1:00 PM)

Poster/Presentation
Number 15-010

Objective To present a rare case of radiographic presentation of cerebral tuberculosis (TB) and concurrent autoimmune encephalitis.

Background Voltage gated potassium channel (VGKC) antibodies are seen in many conditions including limbic encephalitis. It typically involves medial temporal lobe, in rare instances, bilateral cerebellar lobes. Patients can present with seizures and psychiatric involvement like hallucinations. TB tend to prefer posterior fossa and patients present with headaches, seizures and confusion. However, there is no particular association between VGKC encephalitis and disseminated tuberculosis. Presence of both makes the treatment options limited for autoimmune encephalitis. We present a case of a young female with disseminated TB who was also found to have atypical radiographic presentation of TB encephalitis/meningitis and VGKC antibody which is concerning for autoimmune encephalitis.

Design/Methods A case report

Results A 26 year old female with a past medical history of inflammatory bowel syndrome presents with progressive encephalopathy and abdominal distention after a year of study abroad in China. She had behavioral changes including religiosity and worsening hygiene, vomiting, weight loss and progressive lower extremities weakness and mutism. Brain magnetic resonance imaging showed restricted diffusion in cerebellum and bilateral medial thalami and leptomeningeal enhancement and unremarkable imaging of the spine. CT chest/abdomen/pelvis showed loculated left pleural effusion, right hilar and mediastinal lymphadenopathy, hepatomegaly and peritoneal enhancement and complex loculated ascites. Cerebrospinal fluid and cultures were unremarkable, however was positive for voltage gated potassium channel antibody. Peritoneal fluid and lymph node biopsy were positive for TB. Cytology was unremarkable. Had elevated CA125, however low radiographic and clinical suspicion for malignancy. Patient received treatment with steroids and immunoglobulin therapy along with RIPE therapy for disseminated tuberculosis without any other immunosuppressive agent.

Conclusions Treatment of autoimmune encephalitis is limited in the presence of disseminated TB; however, multidisciplinary approach should be used and clinical improvement should be monitored.

Authors/Disclosures
Bhavika Kakadia, DO PRESENTER	Dr. Kakadia has nothing to disclose.
Larisa Syrow, MD	Dr. Syrow has nothing to disclose.

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