Autoimmune Encephalitis: Psychiatry’s Integral Role in Initiation of Treatment
Location
CALS
Publication Date
June 2024
Start Date
1-6-2024 9:00 AM
Description
Autoimmune encephalitis is a form of encephalopathy associated with antibodies against neuronal cell-surface and synaptic proteins that often develops with symptoms resembling those of infectious encephalitis and associated neurological and psychiatric manifestations. The neuropsychiatric features associated with autoimmune encephalitis combined with the difficulty obtaining antibody testing can lead to delays in diagnosis and treatment. Relying on antibody testing instead of clinical decision making in deciding to initiate treatment for autoimmune encephalitis can lead to less than optimal patient outcomes. IVIG is the mainstay treatment for autoimmune encephalitis and has demonstrated success in patients regaining mental capacity; earlier intervention is associated with better outcomes. We present the case of a 35-year-old female with HIV/AIDS and adjustment disorder with depressed mood who presented to University Medical Center in New Orleans with altered mental status. She was admitted to the medicine team for workup of her fever and encephalopathy; initial workup was unremarkable other than an MRI brain with temporal lobe hyperintensity suspicious for encephalitis. During the hospitalization the patient started displaying symptoms consistent with catatonia; subsequently, psychiatry implemented an Ativan challenge. After showing no response to the Ativan challenge, psychiatry recommended initiating IVIG for suspicion of autoimmune encephalitis. The patient showed remarkable improvement in functional and mental capacity and was discharged several days after completing the 5-day IVIG treatment. This case serves as a reminder to include autoimmune encephalitis on the differential for patients presenting in acute encephalopathic states with neuropsychiatric features. This case also demonstrates the impact psychiatrists can make in the diagnosis of autoimmune encephalitis as psychiatrists are often more comfortable in making diagnoses based on clinical features in the absence of labs and imaging. Future research is needed to assess the association between HIV and autoimmune encephalitis, and how immunodeficiency in general is related to autoimmune encephalitis.
Recommended Citation
Morris, Payton; Erwin, Madeline MD; and Nance, Mary MD, "Autoimmune Encephalitis: Psychiatry’s Integral Role in Initiation of Treatment" (2024). Dept. of Psychiatry Research Symposium. 10.
https://digitalscholar.lsuhsc.edu/psych_rd/2024/posters/10
Autoimmune Encephalitis: Psychiatry’s Integral Role in Initiation of Treatment
CALS
Autoimmune encephalitis is a form of encephalopathy associated with antibodies against neuronal cell-surface and synaptic proteins that often develops with symptoms resembling those of infectious encephalitis and associated neurological and psychiatric manifestations. The neuropsychiatric features associated with autoimmune encephalitis combined with the difficulty obtaining antibody testing can lead to delays in diagnosis and treatment. Relying on antibody testing instead of clinical decision making in deciding to initiate treatment for autoimmune encephalitis can lead to less than optimal patient outcomes. IVIG is the mainstay treatment for autoimmune encephalitis and has demonstrated success in patients regaining mental capacity; earlier intervention is associated with better outcomes. We present the case of a 35-year-old female with HIV/AIDS and adjustment disorder with depressed mood who presented to University Medical Center in New Orleans with altered mental status. She was admitted to the medicine team for workup of her fever and encephalopathy; initial workup was unremarkable other than an MRI brain with temporal lobe hyperintensity suspicious for encephalitis. During the hospitalization the patient started displaying symptoms consistent with catatonia; subsequently, psychiatry implemented an Ativan challenge. After showing no response to the Ativan challenge, psychiatry recommended initiating IVIG for suspicion of autoimmune encephalitis. The patient showed remarkable improvement in functional and mental capacity and was discharged several days after completing the 5-day IVIG treatment. This case serves as a reminder to include autoimmune encephalitis on the differential for patients presenting in acute encephalopathic states with neuropsychiatric features. This case also demonstrates the impact psychiatrists can make in the diagnosis of autoimmune encephalitis as psychiatrists are often more comfortable in making diagnoses based on clinical features in the absence of labs and imaging. Future research is needed to assess the association between HIV and autoimmune encephalitis, and how immunodeficiency in general is related to autoimmune encephalitis.