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Novel Antineuronal Autoantibodies With Somatodendritic Staining Pattern in a Patient With Autoimmune Psychosis

BACKGROUND: Autoimmune encephalitis, such as anti-NMDA-receptor encephalitis, typically presenting with subacute onset of neuropsychiatric symptoms, can be detected by antineuronal autoantibodies or inflammatory changes in the cerebrospinal fluid (CSF), as well as pathological alterations in electro...

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Autores principales: Endres, Dominique, Rauer, Sebastian, Pschibul, Alexander, Süß, Patrick, Venhoff, Nils, Runge, Kimon, Feige, Bernd, Denzel, Dominik, Nickel, Kathrin, Schweizer, Tina, Maier, Simon, Egger, Karl, Domschke, Katharina, Meyer, Philipp T., Prüss, Harald, Tebartz van Elst, Ludger
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7424063/
https://www.ncbi.nlm.nih.gov/pubmed/32848899
http://dx.doi.org/10.3389/fpsyt.2020.00627
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author Endres, Dominique
Rauer, Sebastian
Pschibul, Alexander
Süß, Patrick
Venhoff, Nils
Runge, Kimon
Feige, Bernd
Denzel, Dominik
Nickel, Kathrin
Schweizer, Tina
Maier, Simon
Egger, Karl
Domschke, Katharina
Meyer, Philipp T.
Prüss, Harald
Tebartz van Elst, Ludger
author_facet Endres, Dominique
Rauer, Sebastian
Pschibul, Alexander
Süß, Patrick
Venhoff, Nils
Runge, Kimon
Feige, Bernd
Denzel, Dominik
Nickel, Kathrin
Schweizer, Tina
Maier, Simon
Egger, Karl
Domschke, Katharina
Meyer, Philipp T.
Prüss, Harald
Tebartz van Elst, Ludger
author_sort Endres, Dominique
collection PubMed
description BACKGROUND: Autoimmune encephalitis, such as anti-NMDA-receptor encephalitis, typically presenting with subacute onset of neuropsychiatric symptoms, can be detected by antineuronal autoantibodies or inflammatory changes in the cerebrospinal fluid (CSF), as well as pathological alterations in electroencephalography (EEG), magnetic resonance imaging (MRI), or [18F]fluorodeoxyglucose positron emission tomography (FDG PET). For patients with predominant psychotic symptoms, the term autoimmune psychosis was proposed. Here, the authors present the case of a patient with probable autoimmune psychosis associated with unknown antineuronal antibodies. CASE PRESENTATION: A 18-year-old male patient with preexisting autism spectrum disorder developed a severe catatonic syndrome over 2.5 years. The MRI showed normal findings, the EEG depicted intermittent slowing, and the independent component analyses showed additional sharp spikes. However, FDG PET, the basic laboratory analysis and testing of the serum/CSF for well-characterized antineuronal autoantibodies were unsuspicious. The serum and CSF “tissue-based assay” using indirect immunofluorescence on unfixed murine brain tissue revealed antineuronal autoantibodies against an unknown epitope in granule cells in the cerebellum and to neurites of hippocampal interneurons with a somatodendritic staining pattern. The immunosuppressive treatment with high-dose glucocorticoids, plasma exchange, and rituximab led to partial improvement. CONCLUSION: The patient probably suffered from autoantibody-associated autoimmune psychosis. The special features of the case were that the patient (1) presented with mostly inconspicuous basic diagnostics, except for the altered EEG in combination with the detection of CSF autoantibodies directed against a currently unknown epitope, (2) experienced an isolated and long-lasting psychotic course, and (3) had pre-existing autism spectrum disorder. The detection of a probable autoimmune pathophysiology in such cases seems important, as it offers new and more causal immunosuppressive treatment alternatives.
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spelling pubmed-74240632020-08-25 Novel Antineuronal Autoantibodies With Somatodendritic Staining Pattern in a Patient With Autoimmune Psychosis Endres, Dominique Rauer, Sebastian Pschibul, Alexander Süß, Patrick Venhoff, Nils Runge, Kimon Feige, Bernd Denzel, Dominik Nickel, Kathrin Schweizer, Tina Maier, Simon Egger, Karl Domschke, Katharina Meyer, Philipp T. Prüss, Harald Tebartz van Elst, Ludger Front Psychiatry Psychiatry BACKGROUND: Autoimmune encephalitis, such as anti-NMDA-receptor encephalitis, typically presenting with subacute onset of neuropsychiatric symptoms, can be detected by antineuronal autoantibodies or inflammatory changes in the cerebrospinal fluid (CSF), as well as pathological alterations in electroencephalography (EEG), magnetic resonance imaging (MRI), or [18F]fluorodeoxyglucose positron emission tomography (FDG PET). For patients with predominant psychotic symptoms, the term autoimmune psychosis was proposed. Here, the authors present the case of a patient with probable autoimmune psychosis associated with unknown antineuronal antibodies. CASE PRESENTATION: A 18-year-old male patient with preexisting autism spectrum disorder developed a severe catatonic syndrome over 2.5 years. The MRI showed normal findings, the EEG depicted intermittent slowing, and the independent component analyses showed additional sharp spikes. However, FDG PET, the basic laboratory analysis and testing of the serum/CSF for well-characterized antineuronal autoantibodies were unsuspicious. The serum and CSF “tissue-based assay” using indirect immunofluorescence on unfixed murine brain tissue revealed antineuronal autoantibodies against an unknown epitope in granule cells in the cerebellum and to neurites of hippocampal interneurons with a somatodendritic staining pattern. The immunosuppressive treatment with high-dose glucocorticoids, plasma exchange, and rituximab led to partial improvement. CONCLUSION: The patient probably suffered from autoantibody-associated autoimmune psychosis. The special features of the case were that the patient (1) presented with mostly inconspicuous basic diagnostics, except for the altered EEG in combination with the detection of CSF autoantibodies directed against a currently unknown epitope, (2) experienced an isolated and long-lasting psychotic course, and (3) had pre-existing autism spectrum disorder. The detection of a probable autoimmune pathophysiology in such cases seems important, as it offers new and more causal immunosuppressive treatment alternatives. Frontiers Media S.A. 2020-08-06 /pmc/articles/PMC7424063/ /pubmed/32848899 http://dx.doi.org/10.3389/fpsyt.2020.00627 Text en Copyright © 2020 Endres, Rauer, Pschibul, Süß, Venhoff, Runge, Feige, Denzel, Nickel, Schweizer, Maier, Egger, Domschke, Meyer, Prüss and Tebartz van Elst http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Psychiatry
Endres, Dominique
Rauer, Sebastian
Pschibul, Alexander
Süß, Patrick
Venhoff, Nils
Runge, Kimon
Feige, Bernd
Denzel, Dominik
Nickel, Kathrin
Schweizer, Tina
Maier, Simon
Egger, Karl
Domschke, Katharina
Meyer, Philipp T.
Prüss, Harald
Tebartz van Elst, Ludger
Novel Antineuronal Autoantibodies With Somatodendritic Staining Pattern in a Patient With Autoimmune Psychosis
title Novel Antineuronal Autoantibodies With Somatodendritic Staining Pattern in a Patient With Autoimmune Psychosis
title_full Novel Antineuronal Autoantibodies With Somatodendritic Staining Pattern in a Patient With Autoimmune Psychosis
title_fullStr Novel Antineuronal Autoantibodies With Somatodendritic Staining Pattern in a Patient With Autoimmune Psychosis
title_full_unstemmed Novel Antineuronal Autoantibodies With Somatodendritic Staining Pattern in a Patient With Autoimmune Psychosis
title_short Novel Antineuronal Autoantibodies With Somatodendritic Staining Pattern in a Patient With Autoimmune Psychosis
title_sort novel antineuronal autoantibodies with somatodendritic staining pattern in a patient with autoimmune psychosis
topic Psychiatry
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7424063/
https://www.ncbi.nlm.nih.gov/pubmed/32848899
http://dx.doi.org/10.3389/fpsyt.2020.00627
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