Abstract

Morvan’s Fibrillary Chorea and Autoimmune Encephalitis Subsequent to Mycoplasma Pneumonia Infection in a Young Hispanic Female With Rare Autoimmune Antibodies: A Case Report 

 

Surpreet Khunkhun¹  B.Sc, Hyder Tamton² DO, Kamalpreet Mann³ MD, Samir Ruxmohan² DO, Gabriela Perez⁴ DO, Nihal Satyadev¹  MPH, Kunal Aggarwal⁵  B.Sc

 

¹University of Medicine and Health Sciences, St. Kitts and Nevis, WI

²Larkin Community Hospital, South Miami, Florida, USA 

³Mercy Health Hauenstein Neuroscience Center, Grand Rapids, Michigan, USA

⁴Palmetto General Hospital, Hialeah, Florida, USA 

⁵St. George’s University, Grenada, WI

 

Background

Morvan’s syndrome is a rare condition (with male predilection 19:1) that is most commonly associated with thymoma, autoimmune diseases, limbic and paraneoplastic processes. Literature reports cases of Morvan’s associated with autoantibodies to voltage-gated potassium channels complexes (VGKCs). However, there are only a few case reports mentioning NMDA as a cause of Morvan’s and no reports mentioning AMPA, GABA, and anti-GAD65 association with Morvan’s.
 

Aim

To report Morvan’s Fibrillary Chorea and autoimmune encephalitis subsequent to Mycoplasma pneumonia in a young female with CSF positive for VGKC, NMDA, AMPA, GABA, and anti-GAD65 autoimmune antibodies.

Case Description 

We report a young female previously hospitalized due to Mycoplasma pneumonia infection with MRI brain showing multiple strokes involving the basilar artery and the limbic system, requiring anti-edema therapy, VP shunting and decompressive surgery. She then presented to the emergency department with sudden onset hyperesthesia, spontaneous diffuse muscle twitching predominantly in the left side of her neck, severe restlessness, tachycardia in the absence of fever, sleep disturbances, bilateral pupillary dilation, agrypnia excitata and oneiric stupor. Multiple routine EEGs showed moderate, diffuse encephalopathy, but no epileptiform activity. Anticholinergic delirium, serotonin syndrome and neuroleptic malignant syndrome were ruled out. CSF studies showed positive VGKC, NMDA, AMPA, GABA, Anti-GAD65 autoimmune antibodies. The patient’s clinical presentation and lab results both met the criteria for autoimmune encephalitis with concomitant Morvan’s syndrome. A five-day course of IV steroids, a six-day course of IVIG, and subsequently a two-week course of Rituximab was initiated, but the patient showed no improvement. Finally, eight sessions of plasma exchange therapy was performed resulting in marked improvement of her neurological symptoms. 

 

Conclusions

To our group’s knowledge, we present the first case report of Mycoplasma pneumonia as an etiology of autoimmune encephalitis with Morvan’s syndrome in a patient with a unique autoimmune antibody profile.