Lauren A Nguyen, Frishan Rocel O Paulo, Jordan J Petersen, J Douglas Miles
{"title":"One Patient with 3 Antibody-Confirmed Neurological Autoimmune Syndromes: A Case Report and Review of the Literature.","authors":"Lauren A Nguyen, Frishan Rocel O Paulo, Jordan J Petersen, J Douglas Miles","doi":"10.12659/AJCR.948329","DOIUrl":null,"url":null,"abstract":"<p><p>BACKGROUND The occurrence of multiple autoimmune neurological disorders in one patient is rare. Here, we present the case of a woman who exhibited clinical features and antibody titers consistent with myasthenia gravis (MG), neuromyelitis optica (NMO), and anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. CASE REPORT A 37-year-old woman with a 10-year history of MG presented with a sudden loss of central vision in her right eye. Magnetic resonance imaging (MRI) revealed new enhancement of the right optic nerve, and additional cervical and thoracic spine scans showed continuous demyelination of the central cord. Given these findings, a primary demyelinating condition was suspected, and an NMO antibody test confirmed the diagnosis. Two years later, the patient developed significant behavioral changes, including neglecting her usual activities and displaying diminished responsiveness. She became mute and uncooperative with commands. Based on clinical suspicion of anti-NMDAR encephalitis, a comprehensive work-up revealed the presence of NMDAR antibodies, confirming the diagnosis. The patient was treated with plasma exchange, resulting in a marked improvement in her encephalopathy. CONCLUSIONS Over 12 years, this patient developed clinical manifestations of 3 distinct neurological autoimmune disorders. This case underscores the critical need for clinicians to remain alert to overlapping neurological conditions, enabling timely diagnoses and interventions that can help improve clinical outcomes and prevent unnecessary delays in treatment.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e948329"},"PeriodicalIF":0.7000,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12312615/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Case Reports","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.12659/AJCR.948329","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0
Abstract
BACKGROUND The occurrence of multiple autoimmune neurological disorders in one patient is rare. Here, we present the case of a woman who exhibited clinical features and antibody titers consistent with myasthenia gravis (MG), neuromyelitis optica (NMO), and anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. CASE REPORT A 37-year-old woman with a 10-year history of MG presented with a sudden loss of central vision in her right eye. Magnetic resonance imaging (MRI) revealed new enhancement of the right optic nerve, and additional cervical and thoracic spine scans showed continuous demyelination of the central cord. Given these findings, a primary demyelinating condition was suspected, and an NMO antibody test confirmed the diagnosis. Two years later, the patient developed significant behavioral changes, including neglecting her usual activities and displaying diminished responsiveness. She became mute and uncooperative with commands. Based on clinical suspicion of anti-NMDAR encephalitis, a comprehensive work-up revealed the presence of NMDAR antibodies, confirming the diagnosis. The patient was treated with plasma exchange, resulting in a marked improvement in her encephalopathy. CONCLUSIONS Over 12 years, this patient developed clinical manifestations of 3 distinct neurological autoimmune disorders. This case underscores the critical need for clinicians to remain alert to overlapping neurological conditions, enabling timely diagnoses and interventions that can help improve clinical outcomes and prevent unnecessary delays in treatment.
背景:在一名患者中出现多种自身免疫性神经系统疾病是罕见的。在这里,我们提出了一个女性的病例,她表现出的临床特征和抗体滴度与重症肌无力(MG)、视神经脊髓炎(NMO)和抗n -甲基- d -天冬氨酸受体(NMDAR)脑炎一致。病例报告一名37岁女性,有10年MG病史,因右眼中心视力突然丧失。磁共振成像(MRI)显示右侧视神经新的增强,额外的颈椎和胸椎扫描显示中央脊髓持续脱髓鞘。鉴于这些发现,怀疑是原发性脱髓鞘疾病,NMO抗体试验证实了诊断。两年后,患者出现了明显的行为变化,包括忽视日常活动,反应能力下降。她变得沉默寡言,不配合命令。基于对抗NMDAR脑炎的临床怀疑,全面检查显示存在NMDAR抗体,证实了诊断。患者接受血浆置换治疗,脑病明显好转。结论在12年的时间里,该患者出现了3种不同的神经自身免疫性疾病的临床表现。该病例强调了临床医生对重叠的神经系统疾病保持警惕的迫切需要,以便及时诊断和干预,有助于改善临床结果并防止不必要的治疗延误。
期刊介绍:
American Journal of Case Reports is an international, peer-reviewed scientific journal that publishes single and series case reports in all medical fields. American Journal of Case Reports is issued on a continuous basis as a primary electronic journal. Print copies of a single article or a set of articles can be ordered on demand.