Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is an important, treatable cause of encephalitis which remains under-recognised despite a growing body of the literature [1]. It is an immune-mediated syndrome which presents with a variety of neurological symptoms including headache, fever, personality change and seizures. Most case reports to date are of young adults, it is much less frequently reported in older adults. The syndrome has been associated with ovarian teratomas. The prognosis is good with early recognition and treatment, though may relapse. We present a case of NMDA encephalitis in an elderly patient who responded well to immunosuppressive therapy.
colonic mucosa in the same patient (n¼10), and from normal controls (n¼10). Endoscopic (Baron) and histological assessment was made. An iTRAQ-compatible extraction protocol for insoluble IF proteins was developed. Labelled peptides from pooled patients were analysed by SCX-LC-MS/MS (strong cation exchange-reverse phase HPLC tandem mass spectrometry) and data reconstituted in GeneBio Phenyx. Inter-group comparisons were made using in-house algorithms based on t-testing with multiple test correction. Results Median age was 36 years (range 23e71). Endoscopic Baron score was $2 in inflamed mucosa for all patients. Tandem mass spectrometry (MS/MS) identified 52 proteins, 32 (61.5%) matched by two or more peptides, showing significant log fold change, with reduced levels of keratins and vimentin in inflamed mucosa compared to controls (Abstract PMO-250 table 1). Abstract PMO-250 figure 1 shows significantly reduced IF protein levels in inflamed mucosa compared to inactive mucosa. Cytokine proteins neutrophil defensin 1 and bone morphogenetic protein 4 were increased only in actively inflamed mucosa.Abstract Abstract PMO-250 Figure 1 Decreased levels of IF proteins in inflamed colonic mucosa.Conclusion Using a quantitative proteomic approach, we have shown significantly decreased levels of keratins in the actively inflamed colonic mucosa in UC providing further evidence of interaction between keratins and inflammatory pathwaysdwhich requires further elucidation.
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