A complex and severe encephalitis associated with four co-existing neuronal cell-surface autoantibodies

Area of Science:

• Neuroimmunology
• Neurology
• Autoimmune Diseases

Background:

• Autoimmune encephalitis often involves neuronal cell-surface antibodies.
• Co-occurrence of multiple such antibodies is exceptionally rare.

Purpose of the Study:

• To report a unique case of severe autoimmune encephalitis.
• To describe the clinical presentation and immunological findings.
• To discuss the implications of multiple neuronal antibody positivity.

Main Methods:

• Case report of a 28-year-old male patient.
• Detection of NMDA, Glycine, GABA_A, and GABA_B receptor antibodies in serum and CSF using cell-based assays.
• Neuroimaging (MRI), electrophysiology (EEG, EMG), and postmortem examination.

Main Results:

• The patient presented with seizures, confusion, cerebellar signs, opsoclonus, and neuromyotonia.
• Antibodies against NMDA, Glycine, GABA_A, and GABA_B receptors were identified.
• Severe neurological deficits and minimal response to extensive immunotherapy were observed.
• Postmortem findings included pan-cerebellar atrophy and myelopathy.

Conclusions:

• The simultaneous presence of four neuronal cell-surface antibodies is highly unusual.
• This complex overlap syndrome may be associated with a poor prognosis and limited treatment efficacy.
• Highlights the diagnostic and therapeutic challenges in rare autoimmune encephalitis cases.