Abu-Abaa Mohammad, Al-Qaysi Ghassan, Abdulsahib Ali, Jumaah Omar, Ruppel Andre
Internal Medicine, Capital Health Regional Medical Center, Trenton, USA.
Cureus. 2023 Feb 23;15(2):e35365. doi: 10.7759/cureus.35365. eCollection 2023 Feb.
Autoimmune encephalitis is increasingly recognized in clinical practice. We are presenting a 72-year-old female patient who initially presented with a new onset seizure with temporal lobe abnormality on imaging. This was initially attributed to herpes encephalitis although herpes polymerase chain reaction (PCR) was negative. The patient was treated with acyclovir and antiepileptic medication (AEM) with some clinical improvement. She presented again with refractory seizure evolving to status epilepticus. Escalation of AEMs was pursued and positive anti-thyroid peroxidase (TPO) antibody prompted consideration of Hashimoto's encephalitis (HE) and treatment with high-dose corticosteroids and intravenous immunoglobulin (IVIG). However, poor response to steroid argued against HE, and extended autoimmune encephalitis panel revealed positive anti-glutamic acid decarboxylase (GAD) antibody. This case raises the clinical pearl that anti-thyroid antibodies, e.g anti-TPO antibody, can be seen in those with autoimmune encephalopathies other than HE and HE remains a diagnosis of exclusion. It also helps to remind clinicians that a new onset refractory seizure even with temporal lobe changes is not pathognomonic for herpes encephalitis, and although negative serology does not rule out the diagnosis, it is recommended to rule out autoimmune encephalitis as it shares similar clinical and radiological picture.
自身免疫性脑炎在临床实践中越来越受到认可。我们报告一名72岁女性患者，最初表现为新发癫痫发作，影像学检查显示颞叶异常。最初认为是疱疹性脑炎，尽管疱疹聚合酶链反应（PCR）结果为阴性。患者接受了阿昔洛韦和抗癫痫药物（AEM）治疗，临床症状有所改善。她再次出现难治性癫痫发作并演变为癫痫持续状态。遂增加AEM剂量，抗甲状腺过氧化物酶（TPO）抗体阳性提示考虑桥本脑病（HE），给予高剂量糖皮质激素和静脉注射免疫球蛋白（IVIG）治疗。然而，对类固醇治疗反应不佳不支持HE的诊断，扩展的自身免疫性脑炎检测显示抗谷氨酸脱羧酶（GAD）抗体阳性。该病例提示临床要点，即抗甲状腺抗体，如抗TPO抗体，可见于HE以外的自身免疫性脑病患者，HE仍然是一种排除性诊断。它还有助于提醒临床医生，即使有颞叶改变的新发难治性癫痫发作也不是疱疹性脑炎的特征性表现，虽然血清学阴性不能排除诊断，但建议排除自身免疫性脑炎，因为它与疱疹性脑炎有相似的临床和影像学表现。
