Journal Article (Letter)

DZNE-2024-01203

http://join2-wiki.gsi.de/foswiki/pub/Main/Artwork/join2_logo100x88.png Evolution from viral encephalitis to autoimmune encephalitis to multiple sclerosis: a case report

Wurdack, K. ; Prüss, H.DZNE* ; Finke, C.

2024
Springer Heidelberg

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Please use a persistent id in citations: doi:10.1007/s00415-024-12659-9

Abstract: There are established associations between viral and autoimmune encephalitis as well as between autoimmune encephalitis and demyelinating central nervous system (CNS) diseases. Here, we report the evolution from varicella zoster virus (VZV) encephalitis to limbic autoimmune encephalitis (AIE) to multiple sclerosis (MS) in one patient.A woman in her mid-thirties presented with headache, aphasia, and a generalized tonic-clonic seizure. Cerebrospinal fluid (CSF) VZV polymerase chain reaction was positive and treatment with acyclovir was administered for VZV encephalitis. Five months later, the patient presented with cognitive deficits and MRI showed new bilateral hippocampal T2-hyperintensities. CSF analyses revealed pleocytosis and neuropil antibodies in tissue-staining. A diagnosis of limbic AIE was established and treatment with IV steroids and IV immunoglobulins initiated. One year later, the patient developed paresthesia of both legs and magnetic resonance imaging studies now showed new supratentorial and spinal demyelinating lesions. The patient was diagnosed with MS and treatment was changed to rituximab.This unique case report links three important neuroimmunological entities in characterizing the evolution from infectious to autoimmune encephalitis to multiple sclerosis in one patient. Identification of such rare clinical constellations is critical for correct treatment choice and provides important novel insights into the pathophysiology of neuroimmunological disorders including viral triggers and overlap manifestations of autoimmune CNS diseases.

Keyword(s): Humans (MeSH) ; Female (MeSH) ; Multiple Sclerosis: drug therapy (MeSH) ; Multiple Sclerosis: complications (MeSH) ; Multiple Sclerosis: diagnosis (MeSH) ; Adult (MeSH) ; Encephalitis: drug therapy (MeSH) ; Encephalitis: diagnostic imaging (MeSH) ; Encephalitis: diagnosis (MeSH) ; Disease Progression (MeSH) ; Hashimoto Disease: drug therapy (MeSH) ; Hashimoto Disease: diagnosis (MeSH) ; Encephalitis, Varicella Zoster: drug therapy (MeSH) ; Encephalitis, Varicella Zoster: complications (MeSH) ; Limbic Encephalitis: immunology (MeSH) ; Limbic Encephalitis: drug therapy (MeSH) ; Limbic Encephalitis: diagnostic imaging (MeSH) ; Magnetic Resonance Imaging (MeSH) ; Autoimmune encephalitis ; Case report ; Multiple sclerosis ; Neuroimmunology ; Overlap syndrome ; Viral encephalitis

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Contributing Institute(s):

1. Autoimmune Encephalopathies (AG Prüß)

Research Program(s):

1. 353 - Clinical and Health Care Research (POF4-353) (POF4-353)

Appears in the scientific report 2024

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Database coverage:
; ; ; BIOSIS Previews ; Biological Abstracts ; Clarivate Analytics Master Journal List ; Current Contents - Life Sciences ; DEAL Springer ; Ebsco Academic Search ; Essential Science Indicators ; IF >= 5 ; JCR ; Nationallizenz ; SCOPUS ; Science Citation Index Expanded ; Web of Science Core Collection

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