The symptoms: The teenager was referred to an emergency department because she was having hallucinations, including seeing a flying green dinosaur and hearing voices telling her to hurt others. She also had a sense that she was being followed.
During her conversations with ER clinicians, the teen reacted to the vision of the dinosaur as though the creature were present in the room. She reported that she had experienced these hallucinations since seventh grade, so for about four years.
What happened next: Because of the patient's abnormal vital signs, the ER doctors suspected that her hallucinations might be secondary to some physical ailment, such as trauma to the brain, they wrote in a case report. However, a CT scan showed no signs of swelling or hemorrhage in her head. The doctors attempted a lumbar puncture (also called a spinal tap) but failed to collect any cerebrospinal fluid that they could test for irregularities.
On her second day in the hospital, the girl entered a complete catatonic state. Her specific symptoms were not described in the report, but in general, catatonia disrupts how a person processes and reacts to the world around them. Catatonic patients often stop moving and speaking. Doctors treated the patient with lorazepam, which slows down nervous-system signaling, and her catatonia subsided in days.
After the patient had spent eight days in the hospital, psychiatrists recommended that the girl be transferred to their ward. However, this was not possible because she developed problems with feeding herself. Her continued psychotic symptoms were treated with the antipsychotic drug olanzapine.
Based on this finding, the patient was diagnosed with autoimmune encephalitis, a condition in which the body produces antibodies that attack nervous tissue, leading to harmful inflammation that can cause psychiatric symptoms.
The girl was diagnosed with autoimmune encephalitis, a condition in which antibodies attacked her own nervous tissue. (Image credit: Shutterstock)
The treatment: The girl received intravenous infusions of a steroid to reduce inflammation, as well as immunoglobulin — antibodies from healthy donors that are often used to calm autoimmune reactions. She also got an infusion of rituximab, a drug that kills B lymphocytes, a type of white blood cell that makes antibodies like the ones attacking the girl's neurons.
The girl was discharged after having spent almost two months in the hospital. She was treated with ongoing prescriptions of olanzapine and lorazepam, as well as prednisone and monthly immunoglobulin treatments. As her symptoms improved over the following year, she stopped taking the psychiatric drugs but continued her immunotherapy.
Other dilemmasWhat makes the case unique: Autoimmune encephalitis is rare. One study conducted in the U.K. suggests it affects only 5 to 8 out of every 100,000 people. Additionally, most data about the condition in pediatric patients comes from cases caused by autoantibodies that target NMDA receptors, which detect a key chemical messenger in the brain, rather than NIF.
The doctors did not attribute the teen's case to a specific infection, but her family did report that she'd had a cough three weeks before going to the emergency room. The family had visited the Philippines, and the girl and multiple relatives came down with the same illness.
This article is for informational purposes only and is not meant to offer medical advice.
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