一名类风湿性关节炎和 MGUS 患者的抗 LGI1 自身免疫性脑炎

Q3 Medicine
European journal of case reports in internal medicine Pub Date : 2024-06-18 eCollection Date: 2024-01-01 DOI:10.12890/2024_004572
Lamprini Bounou, Aimilios Kaklamanos, Theodoros Androutsakos, Elissavet Kemanetzoglou, Ioanna Moustaka, Athanasios Protogerou, Athina Euthimiou
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引用次数: 0

摘要

背景:抗富含亮氨酸胶质瘤灭活1肢端脑炎(抗LGI1 LE)是最常见的自身免疫性脑炎之一,通常与其他自身免疫性疾病并存。类风湿性关节炎(RA)和意义不明的单克隆丙种球蛋白病(MGUS)通常与自身免疫现象有关。然而,迄今为止,RA 和 MGUS 均未在文献中被描述为与抗 LGI1 LE 同时存在:我们介绍了一名男性类风湿性关节炎患者的抗-LGI1 LE病例,该患者同时还被发现患有MGUS。患者最初接受了皮质类固醇和静脉注射免疫球蛋白的治疗。在轻度复发后,他接受了利妥昔单抗辅助治疗,结果疾病症状完全缓解:我们的报告为抗 LGI1 LE 与 RA 和/或 MGUS 共存提供了证据,从而扩大了对出现神经精神症状、提示脑炎的这些疾病实体患者的鉴别诊断范围。此外,鉴于缺乏治疗指南以及这些疾病在病理生理学和临床层面上的潜在相互作用,本病例还对这些疾病的并存管理提出了挑战:在排除感染性脑炎或中枢神经系统受累等原发疾病的情况下,还应考虑自身免疫性边缘脑炎(LE)。对于确诊为抗-LGI1 LE 的患者,即使在发病数月后,也应广泛检查是否同时存在隐匿的恶性肿瘤前病变。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Anti-LGI1 Autoimmune Encephalitis in a Patient with Rheumatoid Arthritis and MGUS.

Background: Anti-leucine-rich glioma inactivated 1 limbic encephalitis (anti-LGI1 LE) is one of the most frequent autoimmune encephalitis, commonly coexisting with other autoimmune diseases. Rheumatoid arthritis (RA) and monoclonal gammopathy of unknown significance (MGUS) are commonly associated with autoimmune phenomena. However, neither RA nor MGUS have been described in the literature to date as coexisting with anti-LGI1 LE.

Case description: We present the case of anti-LGI1 LE in a male patient with rheumatoid arthritis, who was also found to have an MGUS. The patient was initially treated with corticosteroids and IV immunoglobulin. After a mild relapse, his treatment was complemented with rituximab, resulting in complete regression of the disease symptoms.

Conclusions: Our report provides evidence for the coexistence of anti-LGI1 LE with RA and/or MGUS, thus extending the differential diagnosis of patients suffering with these disease entities that present with neuropsychiatric symptoms suggestive of encephalitis. Moreover, this case raises challenges on the management of the coexistence of these diseases, given the lack of therapeutic guidelines and their potential interaction on a pathophysiological and a clinical level.

Learning points: In a patient with known autoimmune or malignant background who presents with neuropsychiatric symptoms, after excluding infectious encephalitis or central nervous system involvement in the primary disease condition, autoimmune limbic encephalitis (LE) should also be considered.In a patient diagnosed with anti-LGI1 LE there should be an extensive check for coexisting occult pre-malignant conditions, even for months after disease presentation.Clinical management and treatment options of anti-LGI1 LE when coexisting with other autoimmune or pre-malignant conditions can be challenging; thus, more research is needed towards that direction.

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来源期刊
CiteScore
2.10
自引率
0.00%
发文量
166
审稿时长
8 weeks
期刊介绍: The European Journal of Case Reports in Internal Medicine is an official journal of the European Federation of Internal Medicine (EFIM), representing 35 national societies from 33 European countries. The Journal''s mission is to promote the best medical practice and innovation in the field of acute and general medicine. It also provides a forum for internal medicine doctors where they can share new approaches with the aim of improving diagnostic and clinical skills in this field. EJCRIM welcomes high-quality case reports describing unusual or complex cases that an internist may encounter in everyday practice. The cases should either demonstrate the appropriateness of a diagnostic/therapeutic approach, describe a new procedure or maneuver, or show unusual manifestations of a disease or unexpected reactions. The Journal only accepts and publishes those case reports whose learning points provide new insight and/or contribute to advancing medical knowledge both in terms of diagnostics and therapeutic approaches. Case reports of medical errors, therefore, are also welcome as long as they provide innovative measures on how to prevent them in the current practice (Instructive Errors). The Journal may also consider brief and reasoned reports on issues relevant to the practice of Internal Medicine, as well as Abstracts submitted to the scientific meetings of acknowledged medical societies.
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