Anti-LGI1 autoimmune limbic encephalitis: an easy-to-miss diagnosis
Background: Autoimmune limbic encephalitis (ALE) is a rare inflammatory disorder characterised by a subacute onset, usually within weeks. The presence of multiple neuropsychiatric symptoms such as seizures, short-term memory deficits, anxiety and depression often leads to misdiagnosis as another med...
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SMC MEDIA SRL
2024-11-01
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| Series: | European Journal of Case Reports in Internal Medicine |
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| Online Access: | https://www.ejcrim.com/index.php/EJCRIM/article/view/5025 |
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| author | Carolina Freitas Henriques Rui Fernandes Leonor Neves Rubina Miranda Duarte Noronha Teresa Carolina Aguiar Teresa Faria |
| author_facet | Carolina Freitas Henriques Rui Fernandes Leonor Neves Rubina Miranda Duarte Noronha Teresa Carolina Aguiar Teresa Faria |
| author_sort | Carolina Freitas Henriques |
| collection | DOAJ |
| description | Background: Autoimmune limbic encephalitis (ALE) is a rare inflammatory disorder characterised by a subacute onset, usually within weeks. The presence of multiple neuropsychiatric symptoms such as seizures, short-term memory deficits, anxiety and depression often leads to misdiagnosis as another medical condition, contributing to poor prognosis and reduced long-term survival.
Case description: A 60-year-old man, with no chronic illnesses, presented at the emergency department with daily episodes of palpitations, shivering, piloerection and a sense of impending doom lasting two months. Initially diagnosed with anxiety disorder and treated with venlafaxine 50 mg daily, he showed no improvement and developed memory loss. Hospitalised three months later, he exhibited both temporal and spatial disorientation, along with short-term memory loss. Key findings included elevated serum sedimentation rate, hyponatraemia, increased cerebrospinal fluid (CSF) protein levels and cranial magnetic resonance imaging evidence of bilateral temporal intra-parenchymal lesions, suggesting limbic encephalitis. After ruling out alternative diagnoses, screening of autoantibodies in the CSF was requested, which was positive for anti-LGI1 antibodies. The diagnosis of anti-LGI1 ALE was assumed, and treatment was initiated with significant clinical and imaging improvement.
Conclusions: ALE’s broad clinical spectrum contributes to underdiagnosis. Therefore, in patients with new onset of neuropsychiatric symptoms and no prior psychiatric history, ALE should be considered, as prompt diagnosis and treatment are pivotal to achieve a good prognosis. |
| format | Article |
| id | doaj-art-4e73abfb4f484b80ac9e3e3611a2971d |
| institution | OA Journals |
| issn | 2284-2594 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | SMC MEDIA SRL |
| record_format | Article |
| series | European Journal of Case Reports in Internal Medicine |
| spelling | doaj-art-4e73abfb4f484b80ac9e3e3611a2971d2025-08-20T02:38:26ZengSMC MEDIA SRLEuropean Journal of Case Reports in Internal Medicine2284-25942024-11-0110.12890/2024_0050254560Anti-LGI1 autoimmune limbic encephalitis: an easy-to-miss diagnosisCarolina Freitas Henriques0Rui Fernandes1Leonor Neves2Rubina Miranda3Duarte Noronha4Teresa Carolina Aguiar5Teresa Faria6Internal Medicine Department, Hospital Central do Funchal, Funchal, PortugalInternal Medicine Department, Hospital Central do Funchal, Funchal, PortugalInternal Medicine Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, PortugalInternal Medicine Department, Hospital Central do Funchal, Funchal, PortugalNeurology Department, Hospital Central do Funchal, Funchal, PortugalNeurology Department, Hospital Central do Funchal, Funchal, PortugalInternal Medicine Department, Hospital Central do Funchal, Funchal, PortugalBackground: Autoimmune limbic encephalitis (ALE) is a rare inflammatory disorder characterised by a subacute onset, usually within weeks. The presence of multiple neuropsychiatric symptoms such as seizures, short-term memory deficits, anxiety and depression often leads to misdiagnosis as another medical condition, contributing to poor prognosis and reduced long-term survival. Case description: A 60-year-old man, with no chronic illnesses, presented at the emergency department with daily episodes of palpitations, shivering, piloerection and a sense of impending doom lasting two months. Initially diagnosed with anxiety disorder and treated with venlafaxine 50 mg daily, he showed no improvement and developed memory loss. Hospitalised three months later, he exhibited both temporal and spatial disorientation, along with short-term memory loss. Key findings included elevated serum sedimentation rate, hyponatraemia, increased cerebrospinal fluid (CSF) protein levels and cranial magnetic resonance imaging evidence of bilateral temporal intra-parenchymal lesions, suggesting limbic encephalitis. After ruling out alternative diagnoses, screening of autoantibodies in the CSF was requested, which was positive for anti-LGI1 antibodies. The diagnosis of anti-LGI1 ALE was assumed, and treatment was initiated with significant clinical and imaging improvement. Conclusions: ALE’s broad clinical spectrum contributes to underdiagnosis. Therefore, in patients with new onset of neuropsychiatric symptoms and no prior psychiatric history, ALE should be considered, as prompt diagnosis and treatment are pivotal to achieve a good prognosis.https://www.ejcrim.com/index.php/EJCRIM/article/view/5025autoimmune diseaseslimbic encephalitisanti-lgi1 antibodiespsychiatric symptoms |
| spellingShingle | Carolina Freitas Henriques Rui Fernandes Leonor Neves Rubina Miranda Duarte Noronha Teresa Carolina Aguiar Teresa Faria Anti-LGI1 autoimmune limbic encephalitis: an easy-to-miss diagnosis European Journal of Case Reports in Internal Medicine autoimmune diseases limbic encephalitis anti-lgi1 antibodies psychiatric symptoms |
| title | Anti-LGI1 autoimmune limbic encephalitis: an easy-to-miss diagnosis |
| title_full | Anti-LGI1 autoimmune limbic encephalitis: an easy-to-miss diagnosis |
| title_fullStr | Anti-LGI1 autoimmune limbic encephalitis: an easy-to-miss diagnosis |
| title_full_unstemmed | Anti-LGI1 autoimmune limbic encephalitis: an easy-to-miss diagnosis |
| title_short | Anti-LGI1 autoimmune limbic encephalitis: an easy-to-miss diagnosis |
| title_sort | anti lgi1 autoimmune limbic encephalitis an easy to miss diagnosis |
| topic | autoimmune diseases limbic encephalitis anti-lgi1 antibodies psychiatric symptoms |
| url | https://www.ejcrim.com/index.php/EJCRIM/article/view/5025 |
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