Diagnostic Challenges of Bipolar Disorder in a Patient with Autoimmune Encephalitis
Evan Hassan1, Presley Limon1, Hannah Stokan1, Nadeen Gonna2, Paul Brindley2, Ashley Brizendine-Wijayawardana2
1John Sealy School of Medicine, 2Psychiatry and Behavioral Sciences, University of Texas Medical Branch
Objective:
To highlight diagnostic challenges in differentiating autoimmune encephalitis (AE) relapse from primary psychiatric illness in patients with prior seronegative AE presenting with symptoms of acute mania.
Background:
AE commonly presents with prominent psychiatric symptoms, including psychosis, mania, and behavioral dysregulation. In patients with a history of AE-related neuropsychiatric illness, distinguishing relapse from a primary psychiatric disorder is difficult.
We report a case of a 28-year-old male with a history of seronegative AE diagnosed at age 17, with multiple prior relapses responsive to intravenous immunoglobulin (IVIG) and plasmapheresis. Clinical history, collateral information from his family and primary neurologist, hospital course, and treatment response during an inpatient psychiatric admission were reviewed.
Design/Methods:
Case Report
Results:
The patient presented with acute manic symptoms, including decreased need for sleep, impulsivity, hyperreligiosity, irritability, and disorganized thought processes, following several days of minimal sleep and increased substance use. Despite recent empiric IVIG treatment for presumed AE relapse, symptoms persisted. Neurological examination remained stable without new focal deficits or seizures. Collateral from the treating neurologist indicated that the presentation was inconsistent with prior AE relapses. Previous episodes typically followed illnesses, presented with neurological features, and responded to immunotherapy. During hospitalization, the patient was treated with valproate and olanzapine, resulting in progressive symptomatic improvement, including restoration of sleep, mood stabilization, and improved thought organization. No further immunotherapy was administered. The patient was discharged after 15 days with a diagnosis of bipolar I disorder, current episode manic.
Conclusions:
This case underscores the importance of careful clinical differentiation between AE relapse and primary mood disorders in patients with prior AE. Treatment response, longitudinal history, and collateral input are critical in guiding management. Repeat immunotherapy may be avoided when clinical features and course suggest a primary psychiatric etiology, emphasizing the need for multidisciplinary evaluation.
Generative AI Usage
No, did not use generative AI in the drafting or editing in this abstract.
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