Title : Je Ne Sais Quoi — Autoimmune encephalitis in a 19-year-old male: A case report
Abstract:
A 19-year-old Filipino male with no significant past medical history presented with a 1-week history of intermittent headache followed by sudden right-sided weakness, vomiting, twitching, tremors, upward eye-rolling, and spasms with transient loss of consciousness and disorientation. Initial admission revealed hypokalemia and hyperuricemia, for which potassium supplementation and febuxostat were started, while empiric coverage with acyclovir and ceftriaxone was given for suspected infectious etiologies. Neuroimaging and EEG were unremarkable, and he was discharged on levetiracetam. Within days after discharge, vomiting recurred with new-onset left-sided weakness, involuntary shaking, and an episode of collapse with recurrence of upward eye-rolling, prompting readmission. On arrival, he was tachypneic, hypoxemic, and in active spasms with nuchal rigidity and toe hyperextension on examination. He was placed on oxygen support; given benzodiazepines, broad-spectrum antimicrobials, and antiepileptics; and admitted to intensive care. Workup included lumbar puncture with elevated opening pressure and further testing which eventually revealed cerebrospinal fluid positivity for anti-NMDA receptor antibodies. He completed a 5-day course of intravenous immunoglobulin with clinical improvement, resolution of seizures, improved appetite, and no further episodes of agitation, and was subsequently discharged on levetiracetam and a tapering steroid regimen with a follow-up with neurology advised outpatient.
