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Abstract Details

COVID-19 Related Hashimoto's and VGKC Encephalitis
Infectious Disease
P1 - Poster Session 1 (9:00 AM-5:00 PM)
511

We aim to discuss a case of COVID-19-related Hashimoto’s and VGKC Encephalitis 

COVID-19 has been associated with many common neurological sequalae. However, autoimmune encephalitis has been reported only 6 times in the literature.

Retrospective Case Review

A 67-year-old male presented to the ED for dyspnea, tested positive for COVID-19, and was treated accordingly. He began to have frequent anger outbreaks and disorientation. His neurological examination was unremarkable. EEG, MRI brain and CSF studies did not reveal abnormalities. While CSF autoimmune panels were pending (which eventually returned negative), he was administered IVIG and improved somewhat. He was readmitted to the hospital for worsening of his neuropsychiatric condition in 1 month. He was verbally abusive, engaged in impulsive behaviors such as purchasing farm animals and riding motorcycles naked. An MRI brain did not reveal any acute changes. He was started on a course of IVIG. He was advised further workup, but he left against medical advice. He was then admitted again for mania. Serum workup revealed elevated anti-thyroid peroxidase antibodies (71 IU/mL). He was therefore considered as a Hashimoto’s Encephalitis and was given pulse steroids. He had remarkable improvement in both his neuropsychiatric symptoms, with anti-TPO normalization. He then presented to the ED with dyspnea 8 months later and diagnosed again with COVID-19. Subsequently he had increased disorientation and mania. Repeat anti-TPO antibodies were negative. CSF Autoimmune encephalitis panel revealed VGCC N-type antibody (62), AChR Gangionic antibody (112) and VGKC antibody (85). Therefore, this admission he was considered as a COVID-19-related VGKC encephalitis and given pulse steroids with significant improvement. He was discharged home in good condition and was tapered off steroids in the outpatient setting

Per our literature search, this is the only case of both Hashimoto’s and VGKC related encephalitis found in a single patient post-COVID-19.

Authors/Disclosures
Mohammad A. Shahab, MD, MBBS (Cayuga Medical Associates)
PRESENTER
Dr. Shahab has nothing to disclose.
Kehan Zhao, MD (Marshfield Medical Center-Weston) Dr. Zhao has nothing to disclose.
No disclosure on file