CASPR2 positive autoimmune encephalitis presenting as delirium in an alcohol dependent patient: a diagnostic dilemma

Arya  Jith; Kathleen Anne  Mathew; Dinesh  Narayanan; Sheen Maria  Jacob

doi:10.30834/KJP.34.1.2021.265

Authors

Arya Jith Assistant Professor, Department of Psychiatry, Amrita Institute of Medical sciences, Kochi
Kathleen Anne Mathew Senior Resident, Department of Psychiatry, Amrita Institute of Medical Sciences, Kochi
Dinesh Narayanan Professor and Head, Department of Psychiatry, Amrita Institute of Medical Sciences, Kochi
Sheen Maria Jacob Junior Resident, Department of psychiatry, Amrita Institute of Medical Sciences, Kochi

DOI:

https://doi.org/10.30834/KJP.34.1.2021.265

Keywords:

Delirium, autoimmune encephalitis, alcohol withdrawal, CASPR2

Abstract

Delirium, a major psychiatric emergency commonly encountered in alcohol withdrawal state, can have various aetiologies. Here we present a case of protracted delirium in an alcohol dependent patient, which on detailed neurological workup was diagnosed to be autoimmune encephalitis with CASPR2 (contactin-associated protein-like 2) antibodies. Subsequent treatment with immunotherapy and steroids lead to the resolution of symptoms.

References

Fong TG, Tulebaev SR, Inouye SK. Delirium in elderly adults: diagnosis, prevention and treatment. Nat Rev Neurol. 2009 Apr;5(4):210–20.

Dasgupta M, Hillier LM. Factors associated with prolonged delirium: a systematic review. Int Psychogeriatr. 2010 May;22(3):373–94.

van Sonderen A, Schreurs MWJ, Wirtz PW, Sillevis Smitt PAE, Titulaer MJ. From VGKC to LGI1 and Caspr2 encephalitis: The evolution of a disease entity over time. Autoimmun Rev. 2016 Oct;15(10):970–4.

Paul B, Paul G, Singh G, Bansal R. Autoantibody-induced encephalitis. Int J Nutr Pharmacol Neurol Dis. 2014;4(5):44.

Irani SR, Pettingill P, Kleopa KA, Schiza N, Waters P, Mazia C, et al. Morvan syndrome: Clinical and serological observations in 29 cases. Ann Neurol. 2012 Aug;72(2):241–55.

van Sonderen A, Ariño H, Petit-Pedrol M, Leypoldt F, Körtvélyessy P, Wandinger K-P, et al. The clinical spectrum of Caspr2 antibody–associated disease. Neurology. 2016 Aug 2;87(5):521–8.

Ellwardt E, Geber C, Lotz J, Birklein F. Heterogeneous presentation of caspr2 antibody?associated peripheral neuropathy – A case series. Eur J Pain. 2020 Aug;24(7):1411–8.

van Sonderen A, Petit-Pedrol M, Dalmau J, Titulaer MJ. The value of LGI1, Caspr2 and voltage-gated potassium channel antibodies in encephalitis. Nat Rev Neurol. 2017 May;13(5):290–301.