Cabe recalls that this clinical case was approved by the IRB (Institutional Review Board) and was made possible thanks to the collaboration of Dr. José J. Arias Morales, Neurologist and Specialist in Epilepsy; el Dr. Omar Morales Pujals y la Dra. Aracelis Nieves, family doctor of Manatí Mediese Sentrum.
Arachristie Otero Díaz, resident of family medicine, third year Manati Medical Center.
Agencia Latina de Noticias Medicina y Salud Pública
My clinical case consists of a 69-year-old oath of caribbean origin that llega to our emergency room to present a rash diffused in his body, lieu haber comenzado a tomar Carbamazepine.
Prior to the presentation, the patient had been around for several months presenting episodes of complex private convulsions and progressive cognitive dysfunction in each patient being evaluated in outpatient clinics.
On physical examination, the patient is disoriented for a period of time and stays up to date with his ability to compensate like the cranial nerves of 2-12 intact patients. Extremities present a tone and force adequately, without embarrassment, their body mustb a maculopapular diffuse result.
During the hospitalization course, our patient develops complex convulsions that increase in frequency with frequency, requiring multiple medication adjustments to establish the different rates of pain to the most diseased patient. CT / MRI of cabeza both negative for acute pathologies and the electroencephalogram most signals of focal epileptic activity. In addition, the presence of hyponatremia and the negative lumbar puncture identified both for oligoclonal bands as for malignant and infectious etiologies. At this point, it is thought of as an autoimmune process and it takes the patient to methylprednisolone in high doses. The convulsions dramatically resolve 72 hours of his coma. Dos semanas despues the results for the anti-VGKC (gated potassium channel) anticoagulants and anti-LGI1 (Leucine ryk glioom inactivated 1) by sigles in English report positive, confirming the diagnosis of autoimmune encephalitis. Cabe recalls that these tests are not available in Puerto Rico and should be sent to the United States for analysis.
The patient requires a tube of gastrostomy and tracheotomy during hospitalization. Read more about an intrahospital extension of our patient due to high levels of Levetiracetam and Phenobarbital with outpatient follow-up. Three months later, he had no convulsions in convulsions, the patient was evacuated with assistance, verbal communication, the tube of gastrostomy was removed and it was hoped to remove the tube of tracheotomy immediately.
We know how to conceive our patient history, we must know and recognize that Autoinmune Encephalitis is defined as an inflammation of the cerebral cortex that develops with rapid and progressive encephalopathy. When induced by anti-VGKC and anti-LGI1 anticoagulants its incidence is 0.83 cases per million, it has a media age of 60 years and is presented with particular behavioral characteristics such as progressive and abrupt cognitive disorder; high frequency convulsions and hyponatremia in a pattern of anti-diuretic hormone syndrome, which is evidently seen in our patient. We understand that Autoimmune Encephalitis induced by these anticoagulants is rarely seen in Caribbean incidence patients. Our case is only the third case identified in Puerto Rico at the time of writing of our report.
The cardinal characteristics to be able to reconstruct and diagnose this pathology are constantly convulsions and progressive cognitive decline. Cabe mentions that the response to immunotherapy is effective around 70-80% of cases.
In conclusion, as family medicine and vital importance consider Autoimmune Encephalitis in our differential diagnostic team to have described other etiologies. Therefore, we will familiarize ourselves with the common pattern of presentation in order to be able to create a temporary treatment that reduces the likelihood of complications such as slowing down recovery and reducing recurrences. This is an important contrast to the multidisciplinary active team of providers that includes our primary care providers such as base, specialists, families and obviously our patients.