166 Views

523 - Functional Recovery Following Oral Corticosteroids in a Patient With Autoimmune Encephalitis: A Case Report

Thursday, February 27, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

JP

Janay E. Parrish, MD

Resident Physician
Rutgers New Jersey Medical School
Jersey City, New Jersey, United States

Corresponding Author(s)

Jing Lin, MD (she/her/hers)

Fellow Physician
Rutgers New Jersey Medical School
Newark, New Jersey, United States
Neil Jasey, MD

Attending Physican
Kessler Institute for Rehabilitation
West Orange, New Jersey, United States

Case Diagnosis: Autoimmune Encephalitis

Case Description: The patient is a 44 year old male with no past medical history who developed fever, chills, nausea, and vomiting after returning from vacation in Antigua. His symptoms progressed over four days, and he was hospitalized for altered mental status. The patient received empiric antibiotic treatment for presumed meningoencephalitis. His initial MRI demonstrated diffuse leptomeningeal enhancement followed by bilateral hyperintensities involving the thalamus, hypothalamus, and brainstem on repeat imaging. Lumbar puncture showed lymphocytic pleocytosis. EEG was negative for seizure activity.  His infectious and autoimmune work up was negative, except for positive West Nile IgG. He made minimal improvement despite receiving one week of high dose steroids and six cycles of plasmapheresis (PLEX).

Discussions: Upon admission to acute inpatient rehabilitation, the patient was in a minimally conscious state with poor arousal, inconsistent command following, and few spontaneous movements. Functional progress was initially limited despite the addition of numerous neurostimulant medications and participation in a disorders of consciousness program. Oral prednisone was started for suspected autoimmune encephalitis. He showed increased arousal, purposeful movements, and speech output after one week of treatment. After two weeks, he was determined to be emerged from his disorder of consciousness.

Conclusions: First-line treatments for autoimmune encephalitis include high dose corticosteroids, intravenous immunoglobin (IVIG), and PLEX. In cases with refractory clinical response, first-line agents are often used in combination before considering second-line treatments such as Rituximab. Although oral Prednisone has been utilized for maintenance therapy, there is limited evidence evaluating the efficacy of increasing corticosteroid duration during first line treatment. Here, we describe a patient with suspected autoimmune encephalitis who demonstrated significant functional recovery following treatment with oral corticosteroids over several weeks.

Long-term oral corticosteroid therapy may improve functional outcomes in patients with autoimmune encephalitis refractory to standard first line treatment options.