Highlights
- •Autoimmune GFAP astrocytopathy is a kind of novel meningoencephalomyelitis.
- •HSV infection may induce the autoimmune GFAP astrocytopathy.
- •Autoimmune GFAP astrocytopathy might be a new differential diagnosis for relapsing HSV encephalitis.
Abstract
Autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy is a novel autoimmune
disease. This is the first report of a case of autoimmune GFAP astrocytopathy after
herpes simplex viral encephalitis (HSVE). A 35-year-old female patient presented with
a combination of headache, fever, seizure and psychiatric/behavioral abnormalities.
She had GFAP-IgG in both serum and cerebrospinal fluid (CSF). Magnetic resonance imaging
(MRI) with gadolinium-enhancement revealed linear enhancement oriented radially to
the ventricles. After treatment with corticosteroids, her symptoms were alleviated,
the lesions enhancement reduced, and the immunoreactive intensity of GFAP-IgG decreased.
This case shows an observational link between HSVE and autoimmune GFAP astrocytopathy,
suggesting that autoimmune GFAP astrocytopathy may provide a new differential diagnosis
for relapsing HSVE.
Abbreviations:
ANA (anti-nuclear antibodies), CMV (cytomegalovirus), CNS (central nervous system), CSF (cerebrospinal fluid), CT (computed tomography), ENA (anti-extractable nuclear antigen), GFAP (glial fibrillary acidic protein), HSV-1 (herpes simplex virus type 1), HSVE (herpes simplex viral encephalitis), IgG (immunoglobulin G), MMSE (Mini-Mental State Examination), MoCA (Montreal Cognitive Assessment), MRI (magnetic resonance imaging), NGS (next-generation sequencing), RA (rheumatoid arthritis), RV (rubella virus), SS (Sjogren's syndrome)Keywords
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References
- Autoimmune glial fibrillary acidic protein astrocytopathy: a novel meningoencephalomyelitis.JAMA Neurol. 2016; 73: 1297-1307
- Glial fibrillary acidic protein immunoglobulin G as biomarker of autoimmune astrocytopathy: analysis of 102 patients.Ann. Neurol. 2017; 81: 298-309
- Herpes simplex encephalitis: an update.Curr. Infect. Dis. Rep. 2017; 19: 13
- Targeted deletion in astrocyte intermediate filament (Gfap) alters neuronal physiology.Proc. Natl. Acad. Sci. USA. 1996; 93: 6361-6366
- Herpes simplex virus encephalitis: clinical manifestations, diagnosis and outcome in 106 adult patients.J. Clin. Virol. 2014; 60: 112-118
Article info
Publication history
Published online: February 19, 2018
Accepted:
February 13,
2018
Received in revised form:
February 11,
2018
Received:
December 26,
2017
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
