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

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.

Downloads

Published

2021-06-07

How to Cite

Jith, A., Mathew, K. A., Narayanan, D. ., & Jacob, S. M. . (2021). CASPR2 positive autoimmune encephalitis presenting as delirium in an alcohol dependent patient: a diagnostic dilemma. Kerala Journal of Psychiatry, 34(1), 54–56. https://doi.org/10.30834/KJP.34.1.2021.265

Issue

Section

Case Report