[Pubmed] Case report: Seropositive myasthenia gravis complicated by limbic encephalitis positive for antibodies to AMPAR

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Front Neurol. 2023 Oct 12;14:1237140. doi: 10.3389/fneur.2023.1237140. eCollection 2023.

ABSTRACT

OBJECTIVES: Autoantibodies to the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR) and leucine-rich glioma-inactivated 1 (Lgi1) are associated with autoimmune encephalitis. We described an acetylcholine receptor (AChR)-positive patient with myasthenia gravis who developed limbic encephalitis with antibodies to AMPAR and Lgi1.

METHODS: A single-case report with detailed, prospective clinical and biomarker data including serial laboratory testing and histopathology.

RESULTS: A 49-year-old woman was diagnosed with anti-AChR antibody-positive generalized myasthenia gravis in 1983. After 9 months of the removal of thymoma in 1984, she developed influenza-like symptoms and then symptoms of limbic encephalitis. Retrospective analysis of serum showed high concentrations of anti-AMPAR and lower concentrations of anti-Lgi1 antibodies. Cerebral CT was normal, EEG showed bifrontal dysrhythmia, and CSF showed mild pleocytosis. Immuno-histochemical examination of the thymoma confirmed staining for Glur2, a subunit of AMPAR. The patient recovered with mild sequelae, but low levels of anti-AMPAR and anti-Lgi1 antibodies were detectable for over 25 years subsequently.

DISCUSSION: This case confirms earlier reports of AMPAR-associated autoimmune encephalitis co-occurring with thymoma and myasthenia gravis and is unique in its observational length. It shows, moreover, that antibodies to AMPAR and Lgi1 can persist despite clinical recovery.

PMID:37900608 | PMC:PMC10602774 | DOI:10.3389/fneur.2023.1237140


Source: https://pubmed.ncbi.nlm.nih.gov/3790060 ... t6+86293ac