Medical School. University of Azores. Ponta Delgada. Azores. Portugal.
Department of Neurology. Hospital do Divino Espírito Santo. Ponta Delgada. Azores. Portugal.
Acta Med Port. 2021 May 2;34(5):378-382. doi: 10.20344/amp.13793. Epub 2020 Dec 31.
Encephalitis is characterized by inflammation of the brain. Literature describes autoimmune as one of the most common aetiology of non-infectious encephalitis. Given the similarities in clinical, imagological and laboratory findings with viral encephalitis and due to the wide variety of clinical features, the diagnosis is rather challenging and therefore physicians need an increased clinical suspicion to make the correct diagnosis. We report a case of a 35-year-old male with no past medical history that presented with two episodes of autoimmune encephalitis in a 6-month period. Despite having the typical clinical presentation and imagological findings consistent with autoimmune encephalitis, this case had negative results for antibodies, which delayed the diagnosis. It is essential to highlight the importance of considering the hypothesis of autoimmune aetiology on the differential diagnosis of all patients presenting with clinical and magnetic resonance imaging results suggestive of probable encephalitis, regardless of the negative antibodies results. This case clearly depicts the difficulties of diagnosing and treating an autoimmune encephalitis. The main goal of this case report is to increase awareness towards early diagnosis to promptly implement a specific treatment that has proven to improve the outcome and prognosis.
脑炎的特征是大脑炎症。文献描述自身免疫是最常见的非传染性脑炎病因之一。鉴于与病毒性脑炎在临床、影像学和实验室发现方面的相似性,以及由于临床表现的多样性,诊断具有相当的挑战性,因此医生需要提高临床怀疑度才能做出正确的诊断。我们报告了一例 35 岁男性,无既往病史,在 6 个月内出现了两次自身免疫性脑炎发作。尽管具有典型的临床表现和影像学表现符合自身免疫性脑炎,但该病例的抗体检测结果为阴性,这导致了诊断的延迟。重要的是要强调在所有具有可能脑炎的临床和磁共振成像结果的患者的鉴别诊断中考虑自身免疫病因假说的重要性,而不论抗体结果是否为阴性。这个病例清楚地说明了诊断和治疗自身免疫性脑炎的困难。本病例报告的主要目的是提高对早期诊断的认识,以便及时实施已被证明能改善预后的特定治疗。