An unusual presentation of autoimmune encephalitis: a potentially dangerous clinical challenge

Andrea Piccioni¹, Marco Trabucco Aurilio², Chiara Cordischi¹, Rebecca Nicolò¹, Giulia Biscione³, Marcello Candelli¹, Francesco Franceschi ¹, Matteo Bolcato⁴, Emanuele Gilardi¹

¹Emergency Medicine Department, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy - ²Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy - ³Department of Human Neurosciences, Division of Child Neurology and Psychiatry, “Sapienza” University of Rome, Rome, Italy - ⁴Legal Medicine, Department of Molecular Medicine, University of Padua, Via G. Falloppio 50, 35121 Padua, Italy

Introduction: Cases of immune-mediated encephalitis are rare: in literature, there are case reports and prospective studies involving a limited number of patients.

Material and method: We describe the case of a young woman presenting in the emergency department after having visited two other hospitals for new-onset seizure-like focal neurological symptoms associated with fever. Only the patient and her parents witnessed these symptoms. Evaluated in the emergency department and subsequently hospitalized in the suspicion of meningoencephalitis of infectious origin, the patient underwent numerous laboratory and diagnostic tests that excluded said origin. Antiepileptic therapy with levetiracetam was set up. Given the young age of the patient and the female gender, the immune-mediated origin was considered, and high-dose corticosteroid therapy was initiated with progressive improvement of the clinical picture. The patient has been discharged from the Neurology service with indications to continue the antiepileptic therapy, and was organized a follow-up as an outpatient.

Result and conclusion: The purpose of this report is to raise awareness among physicians on the importance of not underestimating neurological symptoms described but not observed at the time of the visit. They can be well described by the patient or by those accompanying him/her, and it is essential to pay attention to any changes in the normal state of the patient they may have noticed, even when they are perceived as disproportionally apprehensive.