Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 16, 2023; 11(2): 408-416
Published online Jan 16, 2023. doi: 10.12998/wjcc.v11.i2.408
Anti-leucine-rich glioma inactivated protein 1 encephalitis with sleep disturbance as the first symptom: A case report and review of literature
De-Lian Kong
De-Lian Kong, Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing 211000, Jiangsu Province, China
Author contributions: Kong DL collected case data and wrotes the manuscript.
Informed consent statement: Written informed consent was obtained from the patient after treatment for publication of this case report and any accompanying images.
Conflict-of-interest statement: All authors declared that they have no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: De-Lian Kong, MD, PhD, Chief Doctor, Chief Physician, Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, No. 169 Hushan Road, Jiangning District, Nanjing 211000, Jiangsu Province, China. xykdl@163.com
Received: September 10, 2022
Peer-review started: September 10, 2022
First decision: November 2, 2022
Revised: November 20, 2022
Accepted: December 5, 2022
Article in press: December 5, 2022
Published online: January 16, 2023
Processing time: 123 Days and 20.3 Hours
Abstract
BACKGROUND

Anti-leucine-rich glioma inactivated protein 1 (anti-LGI1) encephalitis is an infrequent type of autoimmune encephalitis (AE) characterized by acute or subacute cognitive and psychiatric disturbance, facio-brachial dystonic seizures (FBDSs), and hyponatremia. Anti-LGI1 AE has increasingly been considered a primary form of AE. Early identification and treatment of this disease are clearly very important.

CASE SUMMARY

Here, we report that a male patient developed severe anti-LGI1 encephalitis, which was initially misdiagnosed as a sleep disturbance. He was hospitalized for epileptic seizures and typical FBDSs half a month after he developed sleep disturbances. LGI1 antibodies were detected in his cerebrospinal fluid and serum (1:100 and 1:3.2, respectively), which led to the diagnosis of classic anti-LGI1 AE. No obvious abnormality was observed on brain computed tomography images. T2-weighted fluid-attenuated inversion recovery and T2-weighted scans of brain magnetic resonance imaging (MRI) showed slightly elevated signals within the left basal ganglia area. No tumor was detected within the brain of this patient using MRI. After hormone and antiepileptic drug treatment, the patient’s symptoms improved significantly.

CONCLUSION

Anti-LGI1 antibody-associated encephalitis has characteristic clinical manifestations, such as cognitive impairment, psychiatric symptoms, seizures, sleep disorders, hyponatremia, and FBDSs. LGI1 antibodies are present in the serum and/or cerebrospinal fluid, but their production is sensitive to immunosuppressants, and this disease has a relatively good prognosis. In particular, we should be aware of the possibility of anti-LGI1 antibody-associated encephalitis in adolescents with sleep disorders to avoid missed diagnoses and misdiagnoses.

Keywords: Leucine-rich glioma inactivated 1 antibody; Autoimmune encephalitis; Sleep disturbance; Seizures; Facio-brachial dystonic seizures; Case report

Core Tip: Anti-leucine-rich glioma inactivated protein 1 (anti-LGI1) encephalitis is a rare autoimmune encephalitis (AE) characterized by acute or subacute cognitive impairment, facio-brachial dystonic seizures, psychiatric disturbances and hyponatremia. Herein, we report that a male patient developed severe anti-LGI1 encephalitis, which was initially misdiagnosed as sleep disturbance. He had antibodies targeting LGI1 both in his cerebrospinal fluid and serum, which led to the diagnosis of typical anti-LGI1 AE. The case indicated that we should be aware of the possibility of LGI1 antibody-associated encephalitis to avoid missed diagnoses and misdiagnoses especially in adolescents with sleep disorders.