Evolution from viral encephalitis to autoimmune encephalitis to multiple sclerosis: a case report.
Autoimmune encephalitis
Case report
Multiple sclerosis
Neuroimmunology
Overlap syndrome
Viral encephalitis
Journal
Journal of neurology
ISSN: 1432-1459
Titre abrégé: J Neurol
Pays: Germany
ID NLM: 0423161
Informations de publication
Date de publication:
31 Aug 2024
31 Aug 2024
Historique:
received:
03
06
2024
accepted:
20
08
2024
revised:
18
08
2024
medline:
1
9
2024
pubmed:
1
9
2024
entrez:
31
8
2024
Statut:
aheadofprint
Résumé
There are established associations between viral and autoimmune encephalitis as well as between autoimmune encephalitis and demyelinating central nervous system (CNS) diseases. Here, we report the evolution from varicella zoster virus (VZV) encephalitis to limbic autoimmune encephalitis (AIE) to multiple sclerosis (MS) in one patient. A woman in her mid-thirties presented with headache, aphasia, and a generalized tonic-clonic seizure. Cerebrospinal fluid (CSF) VZV polymerase chain reaction was positive and treatment with acyclovir was administered for VZV encephalitis. Five months later, the patient presented with cognitive deficits and MRI showed new bilateral hippocampal T2-hyperintensities. CSF analyses revealed pleocytosis and neuropil antibodies in tissue-staining. A diagnosis of limbic AIE was established and treatment with IV steroids and IV immunoglobulins initiated. One year later, the patient developed paresthesia of both legs and magnetic resonance imaging studies now showed new supratentorial and spinal demyelinating lesions. The patient was diagnosed with MS and treatment was changed to rituximab. This unique case report links three important neuroimmunological entities in characterizing the evolution from infectious to autoimmune encephalitis to multiple sclerosis in one patient. Identification of such rare clinical constellations is critical for correct treatment choice and provides important novel insights into the pathophysiology of neuroimmunological disorders including viral triggers and overlap manifestations of autoimmune CNS diseases.
Sections du résumé
BACKGROUND
BACKGROUND
There are established associations between viral and autoimmune encephalitis as well as between autoimmune encephalitis and demyelinating central nervous system (CNS) diseases. Here, we report the evolution from varicella zoster virus (VZV) encephalitis to limbic autoimmune encephalitis (AIE) to multiple sclerosis (MS) in one patient.
CASE REPORT
METHODS
A woman in her mid-thirties presented with headache, aphasia, and a generalized tonic-clonic seizure. Cerebrospinal fluid (CSF) VZV polymerase chain reaction was positive and treatment with acyclovir was administered for VZV encephalitis. Five months later, the patient presented with cognitive deficits and MRI showed new bilateral hippocampal T2-hyperintensities. CSF analyses revealed pleocytosis and neuropil antibodies in tissue-staining. A diagnosis of limbic AIE was established and treatment with IV steroids and IV immunoglobulins initiated. One year later, the patient developed paresthesia of both legs and magnetic resonance imaging studies now showed new supratentorial and spinal demyelinating lesions. The patient was diagnosed with MS and treatment was changed to rituximab.
CONCLUSIONS
CONCLUSIONS
This unique case report links three important neuroimmunological entities in characterizing the evolution from infectious to autoimmune encephalitis to multiple sclerosis in one patient. Identification of such rare clinical constellations is critical for correct treatment choice and provides important novel insights into the pathophysiology of neuroimmunological disorders including viral triggers and overlap manifestations of autoimmune CNS diseases.
Identifiants
pubmed: 39217218
doi: 10.1007/s00415-024-12659-9
pii: 10.1007/s00415-024-12659-9
doi:
Types de publication
Letter
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s).
Références
Prüss H et al (2012) N-methyl-D-aspartate receptor antibodies in herpes simplex encephalitis. Ann Neurol 72(6):902–911
doi: 10.1002/ana.23689
pubmed: 23280840
pmcid: 3725636
Armangue T et al (2023) Neurologic complications in herpes simplex encephalitis: clinical, immunological and genetic studies. Brain 146(10):4306–19
doi: 10.1093/brain/awad238
pubmed: 37453099
Schäbitz WR et al (2014) VZV brainstem encephalitis triggers NMDA receptor immunoreaction. Neurology 83(24):2309–2311
doi: 10.1212/WNL.0000000000001072
pubmed: 25378669
Prakash PA et al (2019) Anti-NMDAR encephalitis with concomitant varicella zoster virus detection and nonteratomatous malignancy. Neurol Neuroimmunol Neuroinflamm 6(2):e537
doi: 10.1212/NXI.0000000000000537
pubmed: 30697587
Fatma N et al (2022) Atypical anti-NMDA receptor encephalitis associated with varicella zoster virus infection. J Neurovirol 28(3):456–459
doi: 10.1007/s13365-022-01080-5
pubmed: 35604574
Titulaer MJ et al (2014) Overlapping demyelinating syndromes and anti–N-methyl-D-aspartate receptor encephalitis. Ann Neurol 75(3):411–428
doi: 10.1002/ana.24117
pubmed: 24700511
pmcid: 4016175
Zhang S et al (2022) Clinical characteristics of anti-N-methyl-d-aspartate receptor encephalitis overlapping with demyelinating diseases: a review. Front Immunol 13:857443
doi: 10.3389/fimmu.2022.857443
pubmed: 35837405
pmcid: 9273846
Graus F et al (2016) A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol 15(4):391–404
doi: 10.1016/S1474-4422(15)00401-9
pubmed: 26906964
pmcid: 5066574
Thompson AJ et al (2018) Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol 17(2):162–173
doi: 10.1016/S1474-4422(17)30470-2
pubmed: 29275977
Kennedy PGE (2023) The spectrum of neurological manifestations of varicella-zoster virus reactivation. Viruses 15(8):1663
doi: 10.3390/v15081663
pubmed: 37632006
pmcid: 10457770
Prüss H (2021) Autoantibodies in neurological disease. Nat Rev Immunol 21(12):798–813
doi: 10.1038/s41577-021-00543-w
pubmed: 33976421
pmcid: 8111372
Cleaver J et al (2024) The immunobiology of herpes simplex virus encephalitis and post-viral autoimmunity. Brain 147(4):1130–1148
doi: 10.1093/brain/awad419
pubmed: 38092513
Walton C et al (2020) Rising prevalence of multiple sclerosis worldwide: Insights from the Atlas of MS, third edition. Mult Scler 26(14):1816–1821
doi: 10.1177/1352458520970841
pubmed: 33174475
pmcid: 7720355
Bjornevik K et al (2022) Longitudinal analysis reveals high prevalence of Epstein-Barr virus associated with multiple sclerosis. Science 375(6578):296–301
doi: 10.1126/science.abj8222
pubmed: 35025605
Lanz TV et al (2022) Clonally expanded B cells in multiple sclerosis bind EBV EBNA1 and GlialCAM. Nature 603(7900):321–327
doi: 10.1038/s41586-022-04432-7
pubmed: 35073561
pmcid: 9382663
Karaaslan Z et al (2017) A case of seronegative limbic encephalitis with multiple sclerosis: a possible overlapping syndrome. Am J Case Rep 18:64–66
doi: 10.12659/AJCR.901391
pubmed: 28096524
pmcid: 5266202
Reich DS, Lucchinetti CF, Calabresi PA (2018) Multiple sclerosis. N Engl J Med 378(2):169–180
doi: 10.1056/NEJMra1401483
pubmed: 29320652
pmcid: 6942519