The Diagnostic Challenge of Seronegative Autoimmune Encephalitis With Super-Refractory Status Epilepticus

Autoimmune encephalitis is an immune-mediated syndrome, with sub-acute to chronic presentations, such as memory impairment, altered sensorium, behavioral abnormality, psychosis, and seizures. It poses a two-fold diagnostic challenge: firstly, because of its variable clinical presentation and secondly, due to the wide variety of autoimmune antibodies causing it, which makes it difficult to identify the underlying etiology. Treatment should not be delayed due to pending laboratory workup, as early recognition and initiation of therapy prevents long term neurological sequelae. This is a case report of a 59-year-old female who presented with neuropsychiatric symptoms, which evolved into refractory status epilepticus and autonomic dysfunction, requiring anesthesia induced coma. While her MRI had positive findings of encephalitis, she tested negative for infectious diseases and antibody panels.