■自身免疫性脑炎是一种由异常免疫反应引起的神经系统疾病,表现为认知障碍,行为异常,和癫痫发作。其诊断取决于检测血清或脑脊液中的神经元表面抗体。尽管最近在理解方面取得了进展,临床识别仍然具有挑战性,特别是与罕见的抗体,如抗多巴胺D2受体(D2R)和抗二肽基肽酶样蛋白6(DPPX)抗体。延迟诊断可导致严重的并发症。此病例介绍强调了抗D2R和DPPX抗体相关的自身免疫性脑炎的诊断复杂性和有效治疗。
■患者有3天的疲劳和肢体酸痛史,随后出现3小时的精神错乱和肢体抽搐。进入我们的设施后,最初的诊断包括癫痫持续状态,吸入性肺炎,代谢性酸中毒,呼吸性碱中毒,和疑似脑炎.尽管接受了抗癫痫药,抗感染,和抗病毒治疗,病人的病情恶化。大脑的计算机断层扫描(CT)扫描和磁共振成像(MRI)均未显示明显异常。脑脊液(CSF)中未发现病原体。然而,进一步的CSF和血清检查显示抗D2R和抗DPPX抗体的阳性结果,确认抗D2R和DPPX抗体相关的自身免疫性脑炎的诊断。患者接受了综合治疗方案,包括大剂量甲基强的松龙脉冲联合静脉注射免疫球蛋白(IVIG),抗病毒和抗感染治疗,和抗癫痫药物。观察到显著的临床改善,在录取的第18天,患者病情稳定且连贯。
■当前患者是首例报告的抗D2R和DPPX抗体双阳性自身免疫性脑炎病例,以癫痫为突出特征。大剂量甲泼尼龙冲击联合IVIG治疗抗D2R和DPPX抗体阳性自身免疫性脑炎相关癫痫具有显著的安全性和有效性。
Autoimmune encephalitis is a neurological condition caused by abnormal immune responses, manifesting as cognitive impairments, behavioral abnormalities, and seizures. Its diagnosis depends on the detecting neuronal surface antibodies in serum or cerebrospinal fluid. Despite recent advances in understanding, clinical recognition remains challenging, especially with rare antibodies such as anti-dopamine D2 receptor (D2R) and anti-dipeptidyl-peptidase-like protein 6 (DPPX) antibodies. Delayed diagnosis can lead to severe complications. This
case presentation emphasizes the diagnostic intricacies and effective treatment of the anti-D2R and DPPX antibody-associated autoimmune encephalitis.
The patient presented with a 3-day history of fatigue and limb soreness followed by a 3-h episode of confusion and limb convulsions. Upon admission to our facility, the initial diagnosis included status epilepticus, aspiration pneumonia, metabolic acidosis, respiratory alkalosis, and suspected encephalitis. Despite receiving antiepileptic, anti-infection, and antivirus therapy, the patient\'s condition deteriorated. Both computed tomography (CT) scan and magnetic resonance imaging (MRI) of the brain showed no significant abnormalities. No pathogen was identified in the cerebrospinal fluid (CSF). However, further CSF and serum examination revealed positive results of anti-D2R and anti-DPPX antibodies, confirming a diagnosis of anti-D2R and DPPX antibody-associated autoimmune encephalitis. The patient underwent a comprehensive treatment regimen, including high-dose methylprednisolone pulse therapy combined with intravenous immunoglobulin (IVIG), antiviral and anti-infection treatments, and antiepileptic medications. Significant clinical improvement was observed, and by the 18th day of admission, the patient was stable and coherent.
The current patient represents the first reported
case of double-positive autoimmune encephalitis for anti-D2R and DPPX antibodies, with epilepsy as a prominent feature. High-dose methylprednisolone pulse therapy combined with IVIG has shown significant safety and efficacy in treating anti-D2R and DPPX antibody-positive autoimmune encephalitis-associated epilepsy.