Published online Jan 16, 2023. doi: 10.12998/wjcc.v11.i2.408
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
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.
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 symp
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.
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.