A Case of Seronegative Limbic Encephalitis with Multiple Sclerosis: A Possible Overlapping Syndrome

Abstract

Patient: Female, 45Final Diagnosis: Autoimmune encephalitisSymptoms: Memory loss • altered mental status • anhedoniaMedication: Methylprednisolone • immunoglobulinClinical Procedure: ImmunotherapySpecialty: NeurologyObjective:Rare co-existance of disease or pathologyBackground:Autoimmune encephalitis might coexist in patients with autoimmune demyelinating disorders.Case Report:We report on a case of a 45-year-old female multiple sclerosis (MS) patient presenting with acute onset short-term memory loss, altered mental status, inflammatory cerebrospinal fluid (CSF) findings and an MRI lesion on the left temporal lobe. An extensive panel for neuronal autoantibodies proved negative. Neuropsychological symptoms gave a prompt response to immunotherapy but nevertheless control MRI showed left hippocampal atrophy.Conclusions:Several recent reports of concurrent emergence of autoimmune encephalitis and MS suggest a common mechanism for these disorders. Since autoimmune encephalitis and MS share certain common CSF and neuroimaging findings, an increased understanding of overlapping autoimmune brain disorders is required to avoid mis-diagnosis especially in antibody negative autoimmune encephalitis cases.

Diffuse lesions in the limbic system with short‐term memory loss in a patient with multiple sclerosis

“…This is supported by a report that children with relapsing MS more often show autoantibodies against a broader range of CNS antigens compared with children with monophasic demyelinating disorders . In the present case and the case described by Kasaaslan et al ,. no antibodies for limbic encephalitis were detected.…”

“…That patient also showed white matter lesions. Additionally, Kasaaslan et al . reported the case of a patent who was diagnosed with relapsing–remitting MS and who showed acute short‐term memory impairment, as well as time/place disorientation.…”

“…That patient also showed white matter lesions. Additionally, Kasaaslan et al 10 reported the case of a patent who was diagnosed with relapsing-remitting MS and who showed acute short-term memory impairment, as well as time/place disorientation. That patient's MRI showed left medial temporal hyperintensity, and no antibodies associated with limbic encephalitis, such as anti-N-methyl-D-aspartate receptor, were detected.…”

Syndrome and outcome of antibody‐negative limbic encephalitis

“…Previous studies on seronegative LE included isolated case reports with incomplete immunological studies, e.g. published before the description of antibodies closely associated with LE such as GABA B R antibodies, LE associated with systemic autoimmune disorders or LE resulting from immunological adverse effects of immune check-point inhibitors [11][12][13][14][15][16][17][18].…”