Capgras syndrome associated with limbic encephalitis in a patient with diffuse large B-cell lymphoma

Abstract

We report the case of a patient with insidious onset and slowly progressive cognitive impairment, behavioral symptoms, temporal lobe seizures and delusional thoughts typical of delusional misidentification syndromes. Clinical presentation along with extensive diagnostic work-up revealed limbic encephalitis secondary to diffuse large B-cell lymphoma. The patient underwent immunotherapy with high-dose corticosteroid but no significant improvement was observed. No specific treatment for lymphoma was performed because the patient died of septic shock following a nosocomial respiratory infection. Delusional misidentification syndromes are an unusual and unique form of cognitive impairment in which a patient consistently misidentifies persons, places, objects, or events. Capgras syndrome is the most common subtype of this disorder, being defined by the recurrent and transient belief that someone close has been substituted by an imposter. These entities are generally associated with neurodegenerative diseases and psychiatric disturbances. Rare reports of associations between misidentification syndromes and autoimmune diseases such as multiple sclerosis have been published, but no papers address a correlation with limbic encephalitis or lymphoma.

Bortezomib for anti-NMDAR encephalitis following daclizumab treatment in a patient with multiple sclerosis

“…Capgras syndrome has been described in one case of limbic encephalitis, but to our knowledge, not as a feature of NMDAR encephalitis. 6 A case of glial fibrillar acidic proteinα immunoglobulin G -associated encephalitis in a patient with MS on daclizumab treatment was reported. 1 This patient required treatment with methylprednisolone, plasma exchange and rituximab to achieve clinical stability.…”

Wahnhafte Missidentifikation und gewalttätiges Verhalten – Risikoabschätzung und Management

“…Trotzdem wird in der Literatur häufig der Begriff "Wahnhaftes Missidentifikations-Syndrom" verwendet. Neben dem Auftreten von WM bei schizophrenen und organischen Störungen, ist es auch im Zusammenhang mit Hypothyreose [13], Temporallappenischämie [14], Okzipitallappenepilepsie [15], Multipler Sklerose [16], Limbischer Enzephalitis [17] und Posttraumatischer Belastungsstörung [18] beschrieben worden.…”

Prevalence of Capgras syndrome in Alzheimer’s patients: A systematic review and meta-analysis

“…Initially, the etiology of CS seemed to be necessarily linked to psychotic episodes. There are reports of several cases of the syndrome associated with organic pathologies over the years, such as myxedema,7 , 8 encephalitis,9 multiple sclerosis,10 and lithium intoxication 11. In psychotic disorders, Capgras syndrome is still more common today in patients with schizophrenia and degenerative dementias.…”