Abstract Details

Title Diagnostic Challenges of Bipolar Disorder in a Patient with Autoimmune Encephalitis

Topic Autoimmune Neurology

Presentation(s) P1 - Poster Session 1 (12:00 PM-1:00 PM)

Poster/Presentation
Number 1-019

Objective To highlight diagnostic challenges in differentiating autoimmune encephalitis (AE) relapse from primary psychiatric illness in patients with prior seronegative AE presenting with symptoms of acute mania.

Background

AE commonly presents with prominent psychiatric symptoms, including psychosis, mania, and behavioral dysregulation. In patients with a history of AE-related neuropsychiatric illness, distinguishing relapse from a primary psychiatric disorder is difficult.

We report a case of a 28-year-old male with a history of seronegative AE diagnosed at age 17, with multiple prior relapses responsive to intravenous immunoglobulin (IVIG) and plasmapheresis. Clinical history, collateral information from his family and primary neurologist, hospital course, and treatment response during an inpatient psychiatric admission were reviewed.

Design/Methods Case Report

Results The patient presented with acute manic symptoms, including decreased need for sleep, impulsivity, hyperreligiosity, irritability, and disorganized thought processes, following several days of minimal sleep and increased substance use. Despite recent empiric IVIG treatment for presumed AE relapse, symptoms persisted. Neurological examination remained stable without new focal deficits or seizures. Collateral from the treating neurologist indicated that the presentation was inconsistent with prior AE relapses. Previous episodes typically followed illnesses, presented with neurological features, and responded to immunotherapy. During hospitalization, the patient was treated with valproate and olanzapine, resulting in progressive symptomatic improvement, including restoration of sleep, mood stabilization, and improved thought organization. No further immunotherapy was administered. The patient was discharged after 15 days with a diagnosis of bipolar I disorder, current episode manic.

Conclusions This case underscores the importance of careful clinical differentiation between AE relapse and primary mood disorders in patients with prior AE. Treatment response, longitudinal history, and collateral input are critical in guiding management. Repeat immunotherapy may be avoided when clinical features and course suggest a primary psychiatric etiology, emphasizing the need for multidisciplinary evaluation.

Authors/Disclosures
Hannah Stokan, BS PRESENTER	Ms. Stokan has nothing to disclose.
Evan Hassan, BS	Mr. Hassan has nothing to disclose.
Presley Limon, Medical Student	Ms. Limon has nothing to disclose.
Nadeen Gonna, MD	Dr. Gonna has nothing to disclose.
Paul Brindley	Paul Brindley has nothing to disclose.
Ashley Brizendine-Wijayawardana	Ashley Brizendine-Wijayawardana has nothing to disclose.

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