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CASE REPORT article
Front. Immunol.
Sec. Autoimmune and Autoinflammatory Disorders : Autoimmune Disorders
Volume 15 - 2024 |
doi: 10.3389/fimmu.2024.1416019
This article is part of the Research Topic Case Reports in Autoimmune and Autoinflammatory Disorders View all 37 articles
Amnestic syndrome in the course of seronegative limbic encephalitis complicated by drug-resistant epilepsy -a case report
Provisionally accepted- Medical University of Bialystok, Bialystok, Poland
We present the case of a 35-year-old female patient admitted to the hospital with symptoms of rapidly increasing disturbances of consciousness and fever for 48 hours. A lumbar puncture, bacteriological and virological examinations, as well as initial imaging studies, did not show abnormalities. Brain magnetic resonance imaging (MRI), repeated several times, showed hyperintense confluent lesions in both temporal lobes and atrophy of both hippocampus. General examination, cerebrospinal fluid culture, the panel of antineuronal antibodies, and tumor markers remained negative on subsequent repeats. Despite several laboratory and imaging studies, the etiology of the disease could not be established, infections were excluded, and no autoantibodies were found. A diagnosis of probable limbic encephalitis, amnestic syndrome resulting from organic brain damage, and drug-resistant epilepsy was made. The patient, with limbic encephalitis complicated by drug-resistant status epilepticus, was treated with cycles of immunoglobulin and subsequent plasmapheresis. Then she was transferred to the Department of Psychiatry for diagnosis and treatment of intermittent psychotic disorders. During hospitalization, the patient was observed to have multiple epileptic seizures with temporal and frontal morphology, amnestic syndrome covered with confabulations, and periodic psychotic disorders with the occurrence of visual hallucinations. Antiepileptic treatment was escalated by including cenobamate in increasing doses. To control mental disorders, duloxetine, tiapride, and cognitive function exercises were introduced. There was a slight improvement in memory, the cessation of confabulations, and the emergence of the patient's criticism of the symptoms presented. Psychotic symptoms have subsided, and the number of epileptic seizures decreased. The described case portrays a unique coincidence of disease symptoms difficult to treat. It points out the therapeutic difficulties that can occur in patients with suspected autoimmune encephalitis. What is more, it points out the need for multispecialty care of a patient with psychotic symptoms in the course of epilepsy accompanied by amnestic syndrome.
Keywords: 1, Seronegative limbic encephalitis 2, Epilepsy 3, Amnestic syndrome 4, psychotic symptoms
Received: 11 Apr 2024; Accepted: 02 Aug 2024.
Copyright: © 2024 Łoś, Kulikowska, Chorąży, Kułakowska, Waszkiewicz and Galińska- Skok. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Kacper Łoś, Medical University of Bialystok, Bialystok, Poland
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Monika Chorąży