Anti-LGI1 Encephalitis Developing Immunoglobulin Responsive Orthostatic Hypotension after Remission

Orimo, Kenta; Iwata, Nobuyoshi; Kawai, Megumi; Nakajima, Hideki; Takeda, Kazuya; Murai, Hiroyuki; Goto, Jun

doi:10.2169/internalmedicine.5359-20

Cited by 2 publications

(3 citation statements)

References 15 publications

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“…[9] The relationship between autoimmune encephalitis and hypotension is not clear, but several reports have shown that some patients with autoimmune encephalitis developed hypotension or orthostatic hypotension during treatment. [5][6][7]10,11] Among these patients, some had lesions involving the brainstem, [5,7,11] some had lesions in the hippocampal region, and some had specific autoantibodies. [5][6][7]11] These factors may be related to autonomic dysfunction or the influence of the central nervous system on peripheral vascular regulation.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7]10,11] Among these patients, some had lesions involving the brainstem, [5,7,11] some had lesions in the hippocampal region, and some had specific autoantibodies. [5][6][7]11] These factors may be related to autonomic dysfunction or the influence of the central nervous system on peripheral vascular regulation. In our reported case, whether there is a possibility of autoimmune encephalitis following simple herpes virus encephalitis was considered, but due to the patient financial reasons, they refused to undergo further blood and CSF tests to detect related antibodies for autoimmune encephalitis.…”

Section: Discussionmentioning

confidence: 99%

“…In these cases, patients developed refractory hypotension after encephalitis, which significantly prolonged hospitalization time and increased hospitalization times. Kenta Orimo [ 5 ] and others have reported a case of Anti-leucine-rich glioma inactivated 1-associated autoimmune encephalitis in which the patient developed severe orthostatic hypotension 5 years after clinical recovery. The patient orthostatic hypotension quickly improved after immunoglobulin pulse therapy, but severe orthostatic hypotension recurred 2 months later, and gradually recovered after another round of immunoglobulin pulse therapy.…”

Section: Discussionmentioning

confidence: 99%

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A case of successful hormone therapy for refractory hypotension following viral encephalitis: Case report

Zhang,

Liao

2023

Medicine

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Rationale: Refractory hypotension is a life-threatening condition that can result from various causes. We report a rare case of refractory hypotension following herpes simplex virus type 1 encephalitis that was successfully treated with hormone therapy. Patient concerns: The patient was a 66-year-old male who was admitted to the hospital because of fever, chills, convulsions, and impaired consciousness. He developed respiratory failure and was intubated. Cerebrospinal fluid metagenomic sequencing confirmed herpes simplex virus type 1 infection. He received piperacillin-tazobactam for anti-infection, acyclovir for antiviral therapy, and dexamethasone for anti-inflammatory therapy. He had repeated episodes of hypotension despite fluid resuscitation and vasopressor therapy. Diagnosis: The diagnosis of herpes simplex virus type 1 encephalitis complicated by refractory hypotension was based on the patient’s epidemiological history, clinical manifestations, laboratory tests, and imaging studies. Cerebrospinal fluid examination was the most important diagnostic method, which could detect viral nucleic acids. Head magnetic resonance imaging showed a large recent lesion in the right temporal-parietal and insular lobes. Interventions: The treatment of refractory hypotension mainly included anti-infection, antiviral, anti-inflammatory, and hormone therapy. Hormone therapy used methylprednisolone shock treatment until tapering withdrawal. Other treatments included fluid resuscitation, vasopressors, anticonvulsants, etc. Outcomes: The patient’s blood pressure stabilized after receiving methylprednisolone shock treatment, and his mean arterial pressure increased from 73 mm Hg to 92 mm Hg within 24 hours. Three months later, the patient’s blood pressure was normal without medication, and he had a good social and physical recovery. Lessons: This case illustrates the possible role of hormone therapy in restoring blood pressure in patients with refractory hypotension following viral encephalitis. It suggests that adrenal insufficiency or autonomic dysfunction may be involved in the pathophysiology of this condition. Further studies are needed to confirm the efficacy and safety of hormone therapy in this setting.

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