Abstract Details

Title Is It a Lupus Flare? Anti-GAD65 Limbic Encephalitis Presenting With Psychosis in a Patient With Systemic Lupus Erythematosus

Topic Autoimmune Neurology

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

Poster/Presentation
Number 037

Objective To present a case of a 30 year-old female who presented with acute psychosis, initially attributed to a systemic lupus erythematosus (SLE) flare given history of similar presentations, but was found to have Anti-GAD65 limbic encephalitis.

Background Autoimmune encephalitis (AI) has been well recognized to be related to glutamic acid decarboxylase (GAD65) antibodies. SLE can present with neuro-psychiatric symptoms. However, isolated psychosis is a rare presentation and can be indicative of numerous alternative causes, including autoimmune etiologies such as limbic encephalitis. We report a case of GAD65 autoimmune encephalitis in a SLE patient, who presented with psychosis.

Design/Methods A 30 year-old female with SLE presented initially with fever and gait abnormalities that were attributed to SLE flare. She was treated with low dose oral steroids, but several days later developed progressive insomnia, confusion, and psychosis. Workup with computed tomography (CT) and magnetic resonance imaging (MRI) with and without gadolinium contrast of the brain was unremarkable, and routine serum labs were unrevealing. The patient had exhibited similar symptoms in the past that were attributed to SLE flare. The patient was initiated on high dose IV Methylprednisolone for presumed acute SLE psychosis, with marked improvement. Further laboratory workup revealed high titers of Anti-GAD65 antibody, consistent with Anti-GAD65 limbic encephalitis, and was started on immunosuppressive therapy.

Results

N/A

Conclusions SLE patients can present with a wide array of neuropsychiatric symptoms, but clinicians should have high suspicion of alternative etiologies in the setting of psychosis, such as GAD65 encephalitis. Early recognition and appropriate management can yield better outcomes.

Authors/Disclosures
Byron D. Cheon, MD PRESENTER	Dr. Cheon has nothing to disclose.
Amanda R. Sellers, MD (Arabelle City Center)	Dr. Sellers has nothing to disclose.
Fawad Yousuf, MBBS	Dr. Yousuf has nothing to disclose.
Sean T. Kenniff, MD (Memorial Neuroscience Institute)	Dr. Kenniff has nothing to disclose.

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