Autoimmune meningoencephalitis associated with anti‐glutamic acid decarboxylase antibody following COVID‐19 infection: A case report

Salari, Mehri; Harofteh, Bahareh Zaker; Etemadifar, Masoud

doi:10.1002/ccr3.6597

Cited by 2 publications

(3 citation statements)

References 27 publications

(33 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Moreover, GAD65 had the strongest binding capacity to HLA in this work, with two different combinations of mimicry. Cases of autoimmune encephalitis associated with GAD65 have been described following SARS-CoV-2 infection [15,68]. This finding reinforces the association of SARS-CoV-2 MM and the clinical findings related to anti-GAD65 antibody.…”

Section: Discussionsupporting

confidence: 71%

“…Numerous demyelinating disorders such as multiple sclerosis (MS), neuromyelitis optica spectrum diseases (NMOSDs), acute disseminated encephalomyelitis (ADEM), myelitis, and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) have been described as post and para-infectious complications of COVID-19 [6], with the most common forms of AE following SARS-CoV-2 infection being limbic encephalitis and Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis [14]. Important studies have identified the presence of autoantibodies anti-glutamic acid decarboxylase 65-kilodalton isoform (anti-GAD65) [15], anti-myelin oligodendrocyte glycoprotein (anti-MOG), and others [16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Molecular Mimicry between SARS-CoV-2 Proteins and Human Self-Antigens Related with Autoimmune Central Nervous System (CNS) Disorders

Gutman,

Fernandes,

Raposo-Vedovi

et al. 2023

Microorganisms

View full text Add to dashboard Cite

SARS-CoV-2 can trigger autoimmune central nervous system (CNS) diseases in genetically susceptible individuals, a mechanism poorly understood. Molecular mimicry (MM) has been identified in other viral diseases as potential triggers of autoimmune CNS events. This study investigated if MM is the process through which SARS-CoV-2 induces the breakdown of immune tolerance. The frequency of autoimmune CNS disorders was evaluated in a prospective cohort with patients admitted to the COVID-19 Intense Care Unity (ICU) in Rio de Janeiro. Then, an in silico analysis was performed to identify the conserved regions that share a high identity between SARS-CoV-2 antigens and human proteins. The sequences with significant identity and antigenic properties were then assessed for their binding capacity to HLA subtypes. Of the 112 patients included, 3 were classified as having an autoimmune disorder. A total of eleven combinations had significant linear and three-dimensional overlap. NMDAR1, MOG, and MPO were the self-antigens with more significant combinations, followed by GAD65. All sequences presented at least one epitope with strong or intermediate binding capacity to the HLA subtypes selected. This study underscores the possibility that CNS autoimmune attacks observed in COVID-19 patients, including those in our population, could be driven by MM in genetically predisposed individuals.

show abstract

Section: Discussionsupporting

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Molecular Mimicry between SARS-CoV-2 Proteins and Human Self-Antigens Related with Autoimmune Central Nervous System (CNS) Disorders

Gutman,

Fernandes,

Raposo-Vedovi

et al. 2023

Microorganisms

View full text Add to dashboard Cite

show abstract

“…A 44-year- old female patient has been reported under the diagnosis of “meningoencephalitis” associated with GAD65 Abs, 1 month after receiving remdesivir for COVID-19 infection ( Table 1 ). The CT scan showed hydrocephalus and some meningeal enhancement; however, it is unclear whether the findings were related to COVID-19 infection ( 17 ). On the other hand, Triplett and colleagues reported on a 21-year-old female patient with seizures and progressively decreased level of consciousness with MR showing leptomeningeal enhancement aside from prominent hyperintense lesions involving both frontal lobes ( 18 ).…”

Section: Discussionmentioning

confidence: 99%

Meningoencephalitis associated with GAD65 autoimmunity

Kuang

Baizabal‐Carvallo²,

Mofatteh³

et al. 2023

Front. Immunol.

View full text Add to dashboard Cite

BackgroundEncephalitis has been recognized in patients with autoimmunity related to the 65-kDa isoform of glutamic acid decarboxylase (GAD65) antibodies; however, patients with meningoencephalitis associated with those antibodies have been rarely identified in the medical literature. We aimed to define the frequency, clinical features, response to therapy, and functional outcomes of patients with meningoencephalitis associated with GAD antibodies.MethodsWe retrospectively studied consecutive patients attending a tertiary care center for evaluation of an autoimmune neurological disorder from January 2018 to June 2022. The modified Rankin Scale (mRS) was used to assess the functional outcome at the last follow-up.ResultsWe evaluated 482 patients with confirmed autoimmune encephalitis during the study period. Four among the 25 patients with encephalitis related to GAD65 antibodies were identified. One patient was excluded owing to the coexistence of NMDAR antibodies. Three male patients aged 36, 24, and 16 years had an acute (n = 1) or subacute (n = 2) onset of confusion, psychosis, cognitive symptoms, seizures, or tremor. No patient had fever or clinical signs of meningeal irritation. Mild pleocytosis (<100 leukocytes/106) was identified in two patients, whereas one patient had normal CSF. Following immunotherapy with corticosteroids (n = 3) or intravenous immunoglobulin (n = 1), significant improvement was observed in all three cases, achieving a good outcome (mRS 1) in all cases.ConclusionMeningoencephalitis is an uncommon presentation of GAD65 autoimmunity. Patients present with signs of encephalitis but with meningeal enhancement and have good outcomes.

show abstract

Autoimmune meningoencephalitis associated with anti‐glutamic acid decarboxylase antibody following COVID‐19 infection: A case report

Cited by 2 publications

References 27 publications

Molecular Mimicry between SARS-CoV-2 Proteins and Human Self-Antigens Related with Autoimmune Central Nervous System (CNS) Disorders

Molecular Mimicry between SARS-CoV-2 Proteins and Human Self-Antigens Related with Autoimmune Central Nervous System (CNS) Disorders

Meningoencephalitis associated with GAD65 autoimmunity

Contact Info

Product

Resources

About