Autoimmune limbic encephalitis secondary to mixed connective tissue disease (MCTD)
Presentation
Cognitive impairment, psychiatric symptoms, and seizures.
Patient Data
MRI Brain
Bilateral symmetrical T2W/FLAIR hyperintensity in the hippocampus and medial temporal lobes with no evidence of diffusion restriction.
Case Discussion
The patient was admitted with the above-mentioned complaints in ICU. All relevant investigations were done. Lumbar puncture for CSF analysis done was within the normal limit (protein 20, sugar 51, cells TLC 8, L 100%). The patient was started with IV antiepileptic, IV antibiotics, and other supportive medications. MRI brain done here showed symmetrical T2/FLAIR hyperintensities in the bilateral hippocampus and medial temporal lobes. She was started on IV methylprednisolone pulse therapy. Autoimmune and paraneoplastic encephalitis panels were sent and came negative.
Investigation showed anemia (Hb 8.3) raised inflammatory markers (ESR 61, CRP 14.4), and positive rheumatoid factor (284). Anti-CCP and ENA panel was sent. Anti-CCP reports also came out strongly positive. ENA profile came out positive for anti-Sm/RNP positive.
The patient improved symptomatically and was discharged from the hospital in stable condition.
Co-author: Dr. Sanaullah Mudassir (DM, Neuromedicine).
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