Possible Tacrolimus-associated seronegative Autoimmune Encephalitis presenting with subacute cognitive impairment and disorientation - case report
Autoimmune encephalitis (AE) is a multifaceted topic that encompasses various aetiologies and differential diagnoses. In certain instances, the patient’s serum or CSF may not reveal the presence of specific antibodies, which can leave healthcare providers unsure about the most appropriate course of...
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Frontiers Media S.A.
2025-05-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2025.1540960/full |
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| author | Konstantin Hölzl Konstantin Hölzl Francesco Albasini Francesco Albasini Francesco Albasini Francesco Albasini Francesco Albasini |
| author_facet | Konstantin Hölzl Konstantin Hölzl Francesco Albasini Francesco Albasini Francesco Albasini Francesco Albasini Francesco Albasini |
| author_sort | Konstantin Hölzl |
| collection | DOAJ |
| description | Autoimmune encephalitis (AE) is a multifaceted topic that encompasses various aetiologies and differential diagnoses. In certain instances, the patient’s serum or CSF may not reveal the presence of specific antibodies, which can leave healthcare providers unsure about the most appropriate course of treatment. This report outlines the case of a 71 years-old male who underwent a full-size liver transplantation and was subsequently maintained on Tacrolimus for immunosuppression. The patient presented with symptoms of confusion and decreased general orientation, which worsened over time. Following a thorough diagnostic workup, the patient was diagnosed with Antibody-negative Autoimmune Encephalitis (AE). He received treatment with high-dose steroids and Tacrolimus was later changed to Mycophenolate mofetil (MMF), which ameliorated his condition. This case highlights a potential link between long-term use of calcineurin inhibitors and seronegative AE. Hence, it may be advisable to consider Antibody-negative AE (ABnAE) as a potential diagnosis in patients under chronic immunosuppression who exhibit symptoms of sudden cognitive decline. |
| format | Article |
| id | doaj-art-8be22fed9e4a457ba616de3f38dcdb03 |
| institution | OA Journals |
| issn | 2296-858X |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj-art-8be22fed9e4a457ba616de3f38dcdb032025-08-20T02:15:20ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2025-05-011210.3389/fmed.2025.15409601540960Possible Tacrolimus-associated seronegative Autoimmune Encephalitis presenting with subacute cognitive impairment and disorientation - case reportKonstantin Hölzl0Konstantin Hölzl1Francesco Albasini2Francesco Albasini3Francesco Albasini4Francesco Albasini5Francesco Albasini6Medical University of Vienna, Vienna General Hospital, Vienna, AustriaEpileptology and Neurology Centre, University Hospital of Tübingen, Tübingen, GermanyEpileptology and Neurology Centre, University Hospital of Tübingen, Tübingen, GermanyDepartment of Psychiatry and Psychotherapy, University Hospital of Tübingen, Tübingen, GermanyDepartment of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, GermanyDepartment of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, GermanyCentral Institute of Mental Health (CIMH), Mannheim, GermanyAutoimmune encephalitis (AE) is a multifaceted topic that encompasses various aetiologies and differential diagnoses. In certain instances, the patient’s serum or CSF may not reveal the presence of specific antibodies, which can leave healthcare providers unsure about the most appropriate course of treatment. This report outlines the case of a 71 years-old male who underwent a full-size liver transplantation and was subsequently maintained on Tacrolimus for immunosuppression. The patient presented with symptoms of confusion and decreased general orientation, which worsened over time. Following a thorough diagnostic workup, the patient was diagnosed with Antibody-negative Autoimmune Encephalitis (AE). He received treatment with high-dose steroids and Tacrolimus was later changed to Mycophenolate mofetil (MMF), which ameliorated his condition. This case highlights a potential link between long-term use of calcineurin inhibitors and seronegative AE. Hence, it may be advisable to consider Antibody-negative AE (ABnAE) as a potential diagnosis in patients under chronic immunosuppression who exhibit symptoms of sudden cognitive decline.https://www.frontiersin.org/articles/10.3389/fmed.2025.1540960/fullTacrolimuscognitive impairmentAntibody-negative Autoimmune Encephalitisaltered mental stateliver transplantation |
| spellingShingle | Konstantin Hölzl Konstantin Hölzl Francesco Albasini Francesco Albasini Francesco Albasini Francesco Albasini Francesco Albasini Possible Tacrolimus-associated seronegative Autoimmune Encephalitis presenting with subacute cognitive impairment and disorientation - case report Frontiers in Medicine Tacrolimus cognitive impairment Antibody-negative Autoimmune Encephalitis altered mental state liver transplantation |
| title | Possible Tacrolimus-associated seronegative Autoimmune Encephalitis presenting with subacute cognitive impairment and disorientation - case report |
| title_full | Possible Tacrolimus-associated seronegative Autoimmune Encephalitis presenting with subacute cognitive impairment and disorientation - case report |
| title_fullStr | Possible Tacrolimus-associated seronegative Autoimmune Encephalitis presenting with subacute cognitive impairment and disorientation - case report |
| title_full_unstemmed | Possible Tacrolimus-associated seronegative Autoimmune Encephalitis presenting with subacute cognitive impairment and disorientation - case report |
| title_short | Possible Tacrolimus-associated seronegative Autoimmune Encephalitis presenting with subacute cognitive impairment and disorientation - case report |
| title_sort | possible tacrolimus associated seronegative autoimmune encephalitis presenting with subacute cognitive impairment and disorientation case report |
| topic | Tacrolimus cognitive impairment Antibody-negative Autoimmune Encephalitis altered mental state liver transplantation |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2025.1540960/full |
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