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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...
Autores principales: | , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2020
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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. |
format | Online Article Text |
id | pubmed-7424063 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
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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