Autoimmune-Mediated Cognitive Impairment: A Case Report

Abstract

Autoimmune encephalopathy encompasses a complex groupof diseaseswith diverse clinicalmanifestations and therapeutic outcomes. Central nervous system (CNS) autoimmune inflammation can be triggered in multiple ways, including (1) systemic infections/vaccinations, (2) various cancers (paraneoplastic autoimmune encephalitis), (3) systemic autoimmunedisorders, and (4)without an identifiable cause (e.g., nonparaneoplastic autoimmune encephalitis). The discovery of neuropsychiatric disorders associated with antibodies to neuronal cell surface proteins, which play a crucial role in synaptic transmission and plasticity, has resulted in a paradigm shift in our understanding of CNS autoimmunity. We report a case of a young woman with multiple autoimmune disorders who presented with significant memory problems and relapse of major depressive disorder. Her cognitive problems did not resolve upon treatment of depression and continued to result in significant impairment of her daily functioning. A comprehensive neuropsychiatric and neurologic evaluation helped in establishing and providing a successful treatment. This case underscores the importance of recognizing neuropsychiatric manifestations of autoimmune disorders and the use of a multidisciplinary approach for the evaluation and treatment of neuropsychiatric conditions. Medicine, Baltimore, MD; Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH. Send correspondence and reprint requests to Bhargavi Devineni,M.B.B.S., Division of Geriatrics and Neuropsychiatry, Department of Psychiatry, Johns Hopkins University of Medicine, 5300 Alpha Commons Drive 4th Floor, Alpha Commons Building, Baltimore, MD 21224; e-mail: bdevine2@jhmi.edu & 2014TheAcademy of PsychosomaticMedicine. Published by Elsevier Inc. All rights reserved. Case Report