Huang Pan
Department of Neurology, People's Hospital of Deyang City, Deyang 618000, Sichuan Province, China.
World J Clin Cases. 2023 Feb 26;11(6):1379-1384. doi: 10.12998/wjcc.v11.i6.1379.
It is not uncommon to develop viral encephalitis. Epidemic Japanese B encephalitis infection combined with contactin-associated protein-like 2 (CASPR-2) antibody-positive autoimmune encephalitis has not been reported at present. In clinical work, we need to consider more options.
A 32-year-old male worker presented with headache, fever and call-unresponsive presentation. Complete cranial magnetic resonance image showed symmetrical abnormal signals in bilateral medial temporal lobe, bilateral thalamus and basal ganglia. Improved lumbar puncture showed that cerebrospinal fluid protein and cell count increased significantly. Viral encephalitis was considered, and the patient's consciousness still increased rapidly after antiviral treatment. Further detection of Cerebrospinal fluid Japanese B encephalitis virus Polymerase Chain Reaction positive, serum autoimmune encephalitis antibody showed CASPR-2 antibody positive (1:320), the patient's condition gradually improved after plasma exchange treatment. 3 mo later, the serum CASPR-2 antibody was negative and the patient's condition was stable.
This article reports the world's first case of Epidemic Japanese B encephalitis infection combined with CASPR-2 antibody-positive autoimmune encephalitis, with a view to raising awareness.
病毒性脑炎并不罕见。流行性乙型脑炎感染合并接触蛋白相关蛋白样2（CASPR - 2）抗体阳性的自身免疫性脑炎目前尚未见报道。在临床工作中，我们需要考虑更多的可能性。
一名32岁男性工人出现头痛、发热及呼唤无反应表现。头颅磁共振成像显示双侧内侧颞叶、双侧丘脑及基底节区对称性异常信号。腰穿检查显示脑脊液蛋白及细胞计数显著升高。考虑为病毒性脑炎，抗病毒治疗后患者意识仍迅速恶化。进一步检测脑脊液乙型脑炎病毒聚合酶链反应阳性，血清自身免疫性脑炎抗体显示CASPR - 2抗体阳性（1:320），血浆置换治疗后患者病情逐渐好转。3个月后，血清CASPR - 2抗体转阴，患者病情稳定。
本文报道了世界首例流行性乙型脑炎感染合并CASPR - 2抗体阳性的自身免疫性脑炎，以期提高认识。
