Post-COVID-19 Leucine-Rich Glioma Inactivated 1 Autoimmune Limbic Encephalitis in an Aviator.

Abstract

Background: Autoimmune limbic encephalitis is a rare condition. Autoimmune limbic encephalitis after COVID-19 infection is rarer. To date, a handful of cases in nonaviation settings have been reported and their serology were negative for antiprotein leucine-rich glioma inactivated 1 antibody (LGI-1), save two case reports. To the best of our knowledge, this is the first case in aviation environment where positive anti-LGI-1 antibody was detected in serum post-COVID-19 infection.

Case report: 53-yr-old male commercial pilot presented with confabulations and faciobrachial dystonic seizures 6 mo after contracting COVID-19. He had lately failed his scheduled flight simulator check, despite prior uncheckered flying history and proficiency checks. His serum showed mild hyponatremia and was positive for anti-LGI-1 antibody. T2 MRI demonstrated intensity in his temporal lobes. The pilot was treated with high-dose intravenous and oral steroids, intravenous immunoglobulin, plasma exchange, and rituximab. He did not improve and remained grounded from flying duties.

Discussion: LGI-1 autoimmune limbic encephalitis is characterized by clinical manifestation of faciobrachial dystonic seizures and cognitive impairment, commonly affecting short-term memory or amnesia. Laboratory findings such as hyponatraemia and T2 MRI hyperintensity in the temporal lobes should assist in forming a provisional diagnosis which is confirmed by positive anti-LGI-1 serology. There is no cure. Prognosis is guarded with immunotherapy treatment and relapse rates are considerable. It is associated with seizures and tumor. All these factors render the condition not meeting the 1% aeromedical certification rule, and it is incompatible with safe operation of aircraft. Wong MGP. Post-COVID-19 leucine-rich glioma inactivated 1 autoimmune limbic encephalitis in an aviator. Aerosp Med Hum Perform. 2026; 97(6):464-467.