Abstract Details

Title Autoimmune Encephalitis with Hemorrhagic CSF

Topic Autoimmune Neurology

Presentation(s) P2 - Poster Session 2 (2:45 PM-3:45 PM)

Poster/Presentation
Number 040

Objective Autoimmune encephalitis presents a diagnostic challenge, often masquerading with diverse neurological manifestations. We present the case of an 83-year-old female with autoimmune encephalitis, showcasing the intricate interplay between autoimmune mechanisms and viral reactivation.

Background NA

Design/Methods An 83-year-old female with autoimmune encephalitis, despite initial treatment with IVIG for a possible relapse, her cognitive decline, ADLs impairment, and visual hallucinations persisted, prompting referral to our hospital. Neurological examination revealed disorientation, attention deficits, and drowsiness, prompting further investigation. Neuroimaging unveiled subtle hyperintensities in bilateral medial temporal lobes, alongside an incidental nodular infarction. Notably, large vessel occlusion or vasculitis was excluded. Video electroencephalogram demonstrated diffuse slowing indicative of moderate encephalopathy. CSF analysis revealed hemorrhagic fluid with elevated red blood cells (50000 cells/mm3), white blood cells (100 cells/mm3), and protein (670 mg/dl). Remarkably, polymerase chain reaction (PCR) testing detected varicella-zoster virus (VZV) and positive leucine-rich glioma-inactivated 1 (LGI1) antibodies. Prompt intervention with intravenous acyclovir for 14 days was initiated, targeting the detected VZV infection. Subsequent follow-up visits involved resumption of maintenance IVIG therapy.

Results NA

Conclusions This case underscores the importance of comprehensive evaluation in autoimmune encephalitis(AE), as the coexistence of viral infection and autoimmune phenomena poses intricate diagnostic dilemmas. Early recognition and tailored management strategies are paramount for optimizing outcomes in such complex presentations. Our findings emphasize the necessity of vigilance for overlapping etiologies in AE, ensuring timely and targeted therapeutic interventions.

Authors/Disclosures
Abhilash Thatikala, MD, MBBS, DM (UAMS) PRESENTER	Dr. Thatikala has nothing to disclose.
Thirumalaivasan Dhasakeerthi, MBBS (UAMS)	Dr. Dhasakeerthi has nothing to disclose.
Shubham Biyani, MBBS	Dr. Biyani has nothing to disclose.
Hafsa Bareen Syeda, MBBS (UAMS)	Dr. Syeda has nothing to disclose.
Krishna Nalleballe, MD, FAAN	Dr. Nalleballe has nothing to disclose.
Tarek F. Bakdash, MD (Sunshine neurological services, LLC)	Dr. Bakdash has nothing to disclose.

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