Hashimoto’s Encephalopathy Presenting With Altered Mental Status and Myoclonus and Co-Occurring With Psoriasis

Abstract

We report the case of Hashimoto’s encephalopathy (HE) in a 48-year-old male who presented with sudden onset of unresponsiveness with reported confusion and behavioral changes 3 days prior. Metabolic derangement, infectious and toxic factors were ruled out through laboratory testing. Stroke was excluded through brain CT and MRI. Vasculitis panel was unremarkable. Extensive CSF study was unremarkable except for high protein consistent with similar finding in other reported cases of HE. His TSH was normal but his anti-thyroid peroxidase antibody was highly elevated indicative of HE. EEG showed diffuse slow wave pattern. 14-3-3 protein, which is a non-specific marker for Creutzfeldt-Jakob disease, was not detected. The patient showed marked improvement with corticosteroid treatment and his mental status returned to baseline. Our patient also has a history of psoriasis. While HE is reported to be associated with many autoimmune disorders, the currently reported co-occurrence with psoriasis is rare and this report, to the best of our knowledge, is only the second such report. We emphasize that HE should be considered as a differential diagnosis in patients with altered mental status when metabolic, infectious and toxic factors have been ruled out, early onset dementias can be ruled out, and presence of other autoimmune disorders are noted. Anti-thyroid peroxidase (anti-TPO) antibody, although being a non-specific marker, should be checked in such cases. J Med Cases. 2013;4(5):300-303 doi: https://doi.org/10.4021/jmc1144w