Autoimmune encephalitis associated with anti-SOX1 autoantibodies in COVID-19: A case report

Area of Science:

• Neurology
• Infectious Diseases
• Immunology

Background:

• Coronavirus disease 2019 (COVID-19) can manifest with severe non-respiratory complications, including encephalitis.
• Autoimmune encephalitis (AIE) is a rare but serious cause of encephalopathy in COVID-19 patients, often linked to specific autoantibodies.
• Anti-SOX1 autoantibodies are associated with various neurological conditions, including rare paraneoplastic autoimmune encephalitis.

Observation:

• A 28-year-old female with confirmed COVID-19 presented with fever, headache, disorientation, and new-onset refractory status epilepticus.
• Brain imaging was unremarkable, but cerebrospinal fluid analysis revealed pleocytosis and elevated protein, albumin, and immunoglobulin G.
• Electroencephalography suggested AIE, and serologic testing confirmed the presence of anti-SOX1 autoantibodies.

Findings:

• The patient was diagnosed with anti-SOX1 autoimmune encephalitis secondary to COVID-19.
• Treatment with methylprednisolone and intravenous immunoglobulin resulted in rapid clinical improvement, resolving seizures and neurological/psychiatric symptoms.
• Subsequent oncologic screening excluded a paraneoplastic etiology.

Implications:

• This case underscores the importance of considering AIE in COVID-19 patients presenting with neurological symptoms, particularly status epilepticus.
• Early diagnosis and prompt immunotherapy are crucial for favorable outcomes in anti-SOX1 AIE associated with COVID-19.
• The findings contribute to understanding the diverse neurological manifestations of COVID-19 and the role of specific autoantibodies.