Autoimmune Encephalitis Following Bone Marrow Transplantation

Area of Science:

• Pediatric Neurology
• Hematology
• Immunology

Background:

• Neurological complications like encephalopathy and seizures are frequent in bone marrow transplant recipients.
• Common causes include infections, chemotoxicity, graft-versus-host disease, and CNS malignancies.
• Autoimmune encephalitis is recognized in immunocompetent children, but its role post-transplant is unclear.

Purpose of the Study:

• To describe a case of autoimmune encephalitis in a child following bone marrow transplantation.
• To investigate the potential autoimmune mechanisms underlying neurological dysfunction post-transplant.

Main Methods:

• Case report of a 7-year-old boy post-bone marrow transplantation.
• Clinical evaluation for neurological symptoms, including seizures and cognitive deficits.
• Neuroimaging (MRI) and serological testing for autoantibodies (VGKC-associated, LGI1, thyroid).

Main Results:

• The patient presented with behavioral changes, cognitive deficits, and movement abnormalities 15 months post-transplant.
• Evaluation revealed clinical and subclinical seizures, brain MRI hyperintensities, and high titers of VGKC, LGI1, and thyroglobulin antibodies.
• Immunotherapy with corticosteroids and IVIg resulted in significant clinical and neuropsychological improvement, with seizure freedom.

Conclusions:

• Autoimmune encephalitis, specifically limbic encephalitis associated with VGKC/LGI1 antibodies, is a potential, previously undescribed, cause of neurological dysfunction in pediatric bone marrow transplant recipients.
• This case highlights the importance of considering autoimmune etiologies in post-transplant neurological complications.
• Early diagnosis and immunotherapy can lead to favorable outcomes.