Z.A. GONCHAROVA¹, V.A. MEGERYAN², N.M. YAROSH¹, S.M.М. SEHWAIL¹, O.G. STAKANOVA²

¹Rostov State Medical University of the Ministry of Health of the Russian Federation, Rostov-on-Don

²City Hospital № 1 named after N. A. Semashko, Rostov-on-Don

Contact details:

Goncharova Z.A. — M. D., Professor of the Department of Nervous Diseases and Neurosurgery

Address: 34 Sobornyy Alley, Rostov-on-Don, Russian Federation, 344007, tel.: +7-928-100-34-44, e-mail: centrms@mail.ru

A clinical case of chronic encephalitis with pyramidal symptoms and resistant focal epilepsy is presented. The gradual development of symptoms complicated the early diagnosis of the disease. On MRI of the brain, local cystic-gliotic changes were observed without signs of an active inflammatory process. Also, the patient did not show any reliable signs of neuroinfection according to the general analysis and polymerase chain reaction (PCR) of cerebrospinal fluid. According to the results of enzyme-linked immunoelectrodiffusion essay (ELISA) of blood serum in a patient, reactivation of herpes infection was revealed. Against the background of antiherpetic therapy and large doses of anticonvulsants, resistance and status course of symptomatic epilepsy were observed. Positive results of a blood serum test for antibodies to glutamate decarboxylase (anti-GAD antibodies) and presence of positive dynamics during immunosuppressive therapy evidence in favor of the autoimmune process.

Key words: chronic encephalitis, autoimmune encephalitis, herpetic infection, antineuronal antibodies.

(For citation: Goncharova Z.A, Megeryan V.A., Yarosh N.M., Sehwail S.M.М., Stakanova O.G.  Herpes-associated autoimmune encephalitis (clinical case). Practical Medicine. 2019. Vol. 17, № 7, P. 167-169)

REFERENCES

1. Dalmau J., Rosenfeld M.R. Paraneoplastic syndrome of the CNS. Lancet Neurol, 2008, vol. 7 (4), pp. 330–335.
2. Rosenfeld M.R., Titulaer M.J., Dalmau J. Paraneoplastic syndromes and autoimmune encephalitis. Neurology Clinical Practice, 2012, vol. 2 (3), pp. 215–223.
3. Davydovskaya M.V., Boyko A.N., Belyaeva I.A. et al. Autoimmune encephalitis. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova, 2015, vol. 115, no. 4, pp. 95–101 (in Russ.).
4. Lossius A., Johansen J.N., Torkildsen Ø. Et al. Epstein-Barr virus in systemic lupus erythematosus, rheumatoid arthritis and multiple sclerosis-association and causation viruses. Viruses, 2012, vol. 12 (4), pp. 3701–3730.
5. Popova T.E., Shnayder N.A., Petrova M.M. et al. Herpes virus-associated lesions of the central and peripheral nervous system: two clinical cases. Nevrologiya, neyropsikhiatriya, psikhosomatika, 2015, vol. 7, no. 2, pp. 28–34 (in Russ.).
6. Zavalishin I.A., Spirina N.N., Boyko A.N., Nikitina S.S. Khronicheskie neyroinfektsii [Chronic neuroinfection]. Moscow: GEOTAR-Media, 2018. P. 15.
7. Volkova L.I., Sitnikova A.D., Galunova A.B. Autoimmune limbic encephalitis (clinical observation). Ural’skiy meditsinskiy zhurnal, 2018, vol. 166, no. 11, pp. 19–22 (in Russ.).
8. Holle J.F., Jessen F., Kuhn J. Clinical Phenomenology of Autoimmune Encephalitis. Fortschr. Neurol. Psychiatr, 2016, vol. 84 (5), pp. 271–280.
9. Saraya A.W., Wacharapluesadee S., Petcharat S. et al. Normocellular CSF in herpes simplex encephalitis. BMC Res Notes, 2016, vol. 15, pp. 9–95.
10. Incecik F., Herguner O.M. et al. Autoimmune encephalitis associated with glutamic acid decarboxylase antibodies: a case series. Acta Neurol. Belg, 2018, vol. 118 (3), pp. 411–414.
11. Kojima G., Inaba M. et al. PET-positive extralimbic presentation of anti-glutamic acid decarboxylase antibody-associated encephalitis. Epileptic Disord, 2014, vol. 16 (3), pp. 358–361.
12. Niehusmann P., Widman G. et al. Non-paraneoplastic limbic encephalitis and central nervous HHV-6B reactivation: Causality or coincidence? Neuropathology, 2016, vol. 36 (4), pp. 376–380.
13. Poulheim F., Esposito L. et al. Large-scale analysis of herpesviridae in epilepsy-patients with signs of autoimmune encephalitis. Seizure, 2017, vol. 53, pp. 100–102.