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Published on: November 23, 2013
Rapidly progressive neurological deterioration in anti-AMPA receptor encephalitis with additional CRMP5 antibodies
Shuangshuang Yang1, Jie Qin1, Jinghong Li1
1Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe E Rd, Erqi District, Zhengzhou, 450052, Henan, China.
Abstract:
Anti-α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR) encephalitis positive for additional onconeural antibodies is rarely reported. Here we report the clinical features of a patient who developed limbic encephalitis with both glutamate receptor 2 (GluR2) and collapsin response mediator protein 5 (CRMP5) antibodies. Brain magnetic resonance imaging revealed multifocal encephalopathy. Chest computed tomography showed a highly suspicious malignant thymoma. He experienced rapid neurological deterioration during hospitalization. This report indicates that the clinical diversity of anti-AMPAR encephalitis and the presence of onconeural antibodies may lead to poor prognosis.
Insights
Anti-α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR) encephalitis with onconeural antibodies is rare. This case highlights diverse clinical presentations and poor prognosis associated with these co-occurring antibodies.
Area of Science:
- Neuroimmunology
- Oncology
Background:
- Anti-α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR) encephalitis is an autoimmune neurological disorder.
- Co-occurrence of AMPAR antibodies with onconeural antibodies is infrequently documented.
Observation:
- A patient presented with limbic encephalitis, exhibiting both anti-AMPAR (specifically anti-glutamate receptor 2 [GluR2]) and anti-collapsin response mediator protein 5 (CRMP5) antibodies.
- Brain MRI showed multifocal encephalopathy, and chest CT revealed a suspicious thymoma.
- The patient experienced rapid neurological decline during hospitalization.
Findings:
- This case demonstrates the clinical heterogeneity of anti-AMPAR encephalitis.
- The presence of multiple onconeural antibodies, including anti-GluR2 and anti-CRMP5, was noted.
- Rapid neurological deterioration was observed in the patient.
Implications:
- This case underscores the importance of considering diverse clinical presentations in anti-AMPAR encephalitis.
- The co-detection of onconeural antibodies may indicate a poorer prognosis.
- Further research is needed to understand the implications of combined antibody positivity in autoimmune encephalitis.
