Anuraag Gattu1, Chirag Sunil Lalwani 1, Sreelakshmi Narayanan1, Sudheeran Kannoth1, Siby Gopinath1, Vivek Nambiar1, Saraf Udit Umesh1, Gopikrishnan Unnikrishnan1, Anand A Kumar1, Annamma Mathai1
1Amrita Institute of Medical Sciences
Background:
While Autoimmune encephalitis can be associated with other autoimmune disorders, the concurrent presence of autoimmune encephalitis and autoimmune myocarditis is considered uncommon.
Results:
An 82-year-old male with long standing type 2 diabetes mellitus, systemic hypertension, and hypothyroidism presented to the hospital with altered mental status for 8 months. He was admitted for similar complaints earlier in a different hospital and was found to have myasthenia gravis, however therapy was discontinued due to infection. Patient was wheelchair bound with disorientation, proximal limb weakness, hyporeflexia, and bradykinesia. Metabolic workup was normal. MRI brain showed generalized brain atrophy, CSF showed mild elevated protein (58.8mg/dl) without pleocytosis. Diagnosed with UTI with septic encephalopathy, his sensorium didn’t improve with sensitive antibiotic therapy. The diagnosis of a possible autoimmune encephalitis was considered although his antibody studies were negative. Whole body PET CT ruled out malignancy. Echo showed heart global LV hypokinesia, severe LV systolic dysfunction, acetylcholine receptor antibody was positive following which he was planned for IVIg infusion. Following infusion, patient’s sensorium improved, and he was able to walk with support. Monthly infusion of IVIg 400mg/kg was continued as long-term treatment. Upon follow up, patient is walking independently, able to do activities of daily living, without significant memory impairment. Echo heart showed improvement in LV function (moderate LV dysfunction after 2 months, mild after 3 months and good LV systolic function at 4 months). After starting IVIg, no new cardiac medication was started. On last follow up, mRS was 2 (14 months). Hence the improvement in LV function may be attributable to IVIg. Potentially, the patient had a chronic autoimmune myocarditis along with autoimmune encephalitis and the resulting LV dysfunction improved with immunotherapy.
Conclusions:
Our case indicates a potential coexistence of autoimmune encephalitis and autoimmune myocarditis.