Abstract Details

Title Autoimmune encephalitis with Anti-Glutamic Acid Decarboxylase Antibodies preceded by Herpes Simplex Virus Encephalitis

Topic Autoimmune Neurology

Presentation(s) Autoimmune Neurology Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 104

Objective NA

Background Herpes simplex encephalitis (HSE) can trigger autoimmune encephalitis that leads to worsening neurological condition. Post-HSV autoimmune encephalitis is rare, and majority of such cases are associated with anti-N-methyl-D-aspartate receptor (NMDAR) antibodies. Anti-Glutamic Acid Decarboxylase (GAD) antibody can be found in various neurological conditions, mainly stiff-person syndrome, epilepsy, ataxia and limbic encephalitis. Here, we present a rare cases of anti-GAD autoimmune encephalitis with clinical symptoms resembling NMDA encephalitis after HSV encephalitis.

Design/Methods NA

Results A 30-year-old Caucasian male with no remarkable medical history initially presented with altration in behavior, agitation, and auditory hallucination 3 months prior to this admission to our facility. He was first admitted to a psychiatric institute but failed to respond to multiple antipsychotic regimens. Lumbar puncture was done one month after onset of symptoms which revealed positive HSV 1/2 IgG, and he received a 13-day course of IV acyclovir. Clinical condition did not improve thus he was subsequently treated with IV steroids and IVIG for possible NMDA encephalitis. Despite temporarily improvement in his symptoms, he had a relapse in psychiatric symptoms (delusional thought, hallucination and catatonia) when steroid dose was tapered. Brain MRI and EEG were negative. Autoimmune encephalitis panel showed elevated Anti-GAD (90.5 IU/mL, normal range 0.0-5.0) but negative anti-NMDA antibody. Intriguingly, one of his major symptoms was catatonia which responded very well to Lorazepam. He was treated with plasma exchange with significant improvement.

Conclusions Anti-NMDAR encephalitis is the most common post-HSV autoimmune encephalitis which mainly presents with psychiatric symptoms. Here we presented a rare case of Anti-GAD encephalitis after HSE with clinical symptoms mimicking anti-NMDAR encephalitis. To your knowledge, this is the first case report of anti-GAD encephalitis triggered by HSE.

Authors/Disclosures
Dylan T. Warfield, MD PRESENTER	Mr. Warfield has nothing to disclose.
Ahmed Harazeen, MD	Dr. Harazeen has nothing to disclose.
Laura J. Wu, MD, PhD (UTMB Neurology)	Dr. Wu has nothing to disclose.

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