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Overlapping Autoimmune Neurological Syndrome: A Case Report of Triple-Positive Antibody

The presentation of several autoimmune neurological disorders in a single patient is rare and often debilitating. However, early diagnosis and efficacious treatment can lead to a significant recovery. Here, we present an interesting case of a triple antibody-positive autoimmune neurological syndrome...

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Detalles Bibliográficos
Autores principales: Bonner, Kyle, Aboul Nour, Hassan, Memon, Anza B
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9505631/
https://www.ncbi.nlm.nih.gov/pubmed/36168655
http://dx.doi.org/10.7759/cureus.29379
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author Bonner, Kyle
Aboul Nour, Hassan
Memon, Anza B
author_facet Bonner, Kyle
Aboul Nour, Hassan
Memon, Anza B
author_sort Bonner, Kyle
collection PubMed
description The presentation of several autoimmune neurological disorders in a single patient is rare and often debilitating. However, early diagnosis and efficacious treatment can lead to a significant recovery. Here, we present an interesting case of a triple antibody-positive autoimmune neurological syndrome patient who manifested the clinical features of neuromyelitis optica (NMO) spectrum disorder (NMOSD), N-methyl-D-aspartate (NMDA) receptor (NMDAR) encephalitis, and myasthenia gravis (MG). Hence, the patient manifested both central and peripheral nervous system immune-mediated neurological syndromes. A middle-aged female with a history of seropositive aquaporin-4 (AQP4) NMOSD on mycophenolate 1 g twice daily presented with severe fatigue and right eye ptosis (three months since NMOSD diagnosis) and tested positive for acetylcholine receptor (AchR) binding antibody, consistent with MG. Six months after the patient’s NMOSD diagnosis, she began to experience subacute progressive cognitive decline, behavioral changes, imbalance, anxiety/panic attacks, and paranoid delusions. NMDAR encephalitis was suspected, and she tested positive for cerebrospinal fluid NMDAR antibodies. After treatment with steroids failed, she was given two doses of rituximab 1 g, two weeks apart, and reported improvement in her symptoms shortly after the second dose.
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spelling pubmed-95056312022-09-26 Overlapping Autoimmune Neurological Syndrome: A Case Report of Triple-Positive Antibody Bonner, Kyle Aboul Nour, Hassan Memon, Anza B Cureus Neurology The presentation of several autoimmune neurological disorders in a single patient is rare and often debilitating. However, early diagnosis and efficacious treatment can lead to a significant recovery. Here, we present an interesting case of a triple antibody-positive autoimmune neurological syndrome patient who manifested the clinical features of neuromyelitis optica (NMO) spectrum disorder (NMOSD), N-methyl-D-aspartate (NMDA) receptor (NMDAR) encephalitis, and myasthenia gravis (MG). Hence, the patient manifested both central and peripheral nervous system immune-mediated neurological syndromes. A middle-aged female with a history of seropositive aquaporin-4 (AQP4) NMOSD on mycophenolate 1 g twice daily presented with severe fatigue and right eye ptosis (three months since NMOSD diagnosis) and tested positive for acetylcholine receptor (AchR) binding antibody, consistent with MG. Six months after the patient’s NMOSD diagnosis, she began to experience subacute progressive cognitive decline, behavioral changes, imbalance, anxiety/panic attacks, and paranoid delusions. NMDAR encephalitis was suspected, and she tested positive for cerebrospinal fluid NMDAR antibodies. After treatment with steroids failed, she was given two doses of rituximab 1 g, two weeks apart, and reported improvement in her symptoms shortly after the second dose. Cureus 2022-09-20 /pmc/articles/PMC9505631/ /pubmed/36168655 http://dx.doi.org/10.7759/cureus.29379 Text en Copyright © 2022, Bonner et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Neurology
Bonner, Kyle
Aboul Nour, Hassan
Memon, Anza B
Overlapping Autoimmune Neurological Syndrome: A Case Report of Triple-Positive Antibody
title Overlapping Autoimmune Neurological Syndrome: A Case Report of Triple-Positive Antibody
title_full Overlapping Autoimmune Neurological Syndrome: A Case Report of Triple-Positive Antibody
title_fullStr Overlapping Autoimmune Neurological Syndrome: A Case Report of Triple-Positive Antibody
title_full_unstemmed Overlapping Autoimmune Neurological Syndrome: A Case Report of Triple-Positive Antibody
title_short Overlapping Autoimmune Neurological Syndrome: A Case Report of Triple-Positive Antibody
title_sort overlapping autoimmune neurological syndrome: a case report of triple-positive antibody
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9505631/
https://www.ncbi.nlm.nih.gov/pubmed/36168655
http://dx.doi.org/10.7759/cureus.29379
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