Seronegative Autoimmune Limbic Encephalitis A Case Report
Written By : Dr. Nandita Mohan
Medically Reviewed By : Dr. Kamal Kant Kohli
Published On 2022-09-08 04:15 GMT | Update On 2022-09-08 04:15 GMT
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Autoimmune limbic encephalitis (LE) is a subset of acute encephalitis characterized by inflammation of the limbic cerebral cortex. Cognitive decline, behavioral disturbance, and seizures are its cardinal manifestations.
The study in JAPI reports a case of a 70-year-old man with subacute progressive gait imbalance, cognitive impairment, and psychiatric manifestations. Extensive serum and cerebrospinal fluid (CSF) investigations did not reveal any abnormality.
Autoimmune and paraneoplastic encephalitis antibody panels were negative. Magnetic resonance imaging (MRI) and positron emission tomography (PET) brain scans suggested limbic encephalitis. He responded well to immunotherapy.
This case illustrates that acute encephalitis must be suspected in the appropriate setting, even in the absence of a specific antibody. These patients should be given the benefit of early immunotherapy.
All his routine blood investigations, venereal disease research laboratory, HIV, vitamins B1, B12, and E, thyroid profile, and thyroid antibodies were normal. His chest X-ray and abdominal ultrasound were normal. His systemic and paraneoplastic antibody and tumor marker profiles were also negative. The MRI and PET brain scans were normal. As his symptoms were mild and did not impact his daily activities, he was sent home. Unfortunately, he was lost to follow-up for 6 months.
This case brings the importance of remaining vigilant to the possibility of acute encephalitis, even if antibody panels are negative. Seronegative acute encephalitis can be diagnosed on clinical grounds along with ancillary investigations. A delay in diagnosis leads to poor outcomes, so a high index of suspicion is required for its diagnosis.
Reference: Aendole D, Lalkaka J, Jade J, et al. Seronegative Autoimmune Limbic Encephalitis: A Case Report. J Assoc Physicians India 2022;70 (9):88–89.
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