Abstract Details

Title Case Report of Autoimmune Encephalitis with Autoimmune Myocarditis

Topic Autoimmune Neurology

Presentation(s) P5 - Poster Session 5 (5:30 PM-6:30 PM)

Poster/Presentation
Number 14-017

Objective NA

Background While Autoimmune encephalitis can be associated with other autoimmune disorders, the concurrent presence of autoimmune encephalitis and autoimmune myocarditis is considered uncommon.

Design/Methods NA

Results An 82-year-old male with long standing type 2 diabetes mellitus, systemic hypertension, and hypothyroidism presented to the hospital with altered mental status for 8 months. He was admitted for similar complaints earlier in a different hospital and was found to have myasthenia gravis, however therapy was discontinued due to infection. Patient was wheelchair bound with disorientation, proximal limb weakness, hyporeflexia, and bradykinesia. Metabolic workup was normal. MRI brain showed generalized brain atrophy, CSF showed mild elevated protein (58.8mg/dl) without pleocytosis. Diagnosed with UTI with septic encephalopathy, his sensorium didn’t improve with sensitive antibiotic therapy. The diagnosis of a possible autoimmune encephalitis was considered although his antibody studies were negative. Whole body PET CT ruled out malignancy. Echo showed heart global LV hypokinesia, severe LV systolic dysfunction, acetylcholine receptor antibody was positive following which he was planned for IVIg infusion. Following infusion, patient’s sensorium improved, and he was able to walk with support. Monthly infusion of IVIg 400mg/kg was continued as long-term treatment. Upon follow up, patient is walking independently, able to do activities of daily living, without significant memory impairment. Echo heart showed improvement in LV function (moderate LV dysfunction after 2 months, mild after 3 months and good LV systolic function at 4 months). After starting IVIg, no new cardiac medication was started. On last follow up, mRS was 2 (14 months). Hence the improvement in LV function may be attributable to IVIg. Potentially, the patient had a chronic autoimmune myocarditis along with autoimmune encephalitis and the resulting LV dysfunction improved with immunotherapy.

Conclusions Our case indicates a potential coexistence of autoimmune encephalitis and autoimmune myocarditis.

Authors/Disclosures
Anuraag Gattu PRESENTER	Mr. Gattu has nothing to disclose.
Chirag S. Lalwani, MBBS (University of Arkansas Medical Sciences)	Dr. Lalwani has nothing to disclose.
Sreelakshmi N	SREELAKSHMI N has nothing to disclose.
Sudheeran Kannoth (Amrita Institute of Medical Sciences and Research Centre)	The institution of Sudheeran Kannoth has received research support from ICMR.
Sibi Gopinath	No disclosure on file
Vivek K. Nambiar, DM (Amrita Institute)	Dr. Nambiar has nothing to disclose.
Udit U. Saraf, MD, MBBS (Amrita Institute of Medical Sciences)	Dr. Saraf has nothing to disclose.
Gopikrishnan Unnikrishnan (Amrita Institute of Medical Sciences and Research Centre)	Gopikrishnan Unnikrishnan has nothing to disclose.
Anand Kumar	No disclosure on file
Annamma Mathai (Amrita Institute of Medical Sciences and Research Centre)	Annamma Mathai has nothing to disclose.

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