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April 14, 2020; 94 (15 Supplement) Wednesday, April 29

Zic4 Antibody Positive Autoimmune Encephalitis Responding to Rituximab After Failing First Line Therapies: A Case Report (2233)

Mays Alani, Fabian Rossi, Michael Hoffmann, Lourdes Benes-Cases, Umesh Sharma, Nina Tsakadze
First published April 14, 2020,
Mays Alani
1Neurology, University of Central Florida
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Fabian Rossi
2Neurology, Orlando VA Medical Center
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Michael Hoffmann
3Orlando VA Medical Center
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Lourdes Benes-Cases
3Orlando VA Medical Center
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Umesh Sharma
3Orlando VA Medical Center
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Nina Tsakadze
3Orlando VA Medical Center
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Citation
Zic4 Antibody Positive Autoimmune Encephalitis Responding to Rituximab After Failing First Line Therapies: A Case Report (2233)
Mays Alani, Fabian Rossi, Michael Hoffmann, Lourdes Benes-Cases, Umesh Sharma, Nina Tsakadze
Neurology Apr 2020, 94 (15 Supplement) 2233;

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Abstract

Objective: NA

Background: We present a 67 year old man admitted with progressive generalized weakness and altered mental status, found to have autoimmune encephalitis after his CSF tested positive for a rare onconeural antibody Zic4. Patients with Zic4 antibodies have been found to present with a cerebellar syndrome which correlated with his MRI brain findings of generalized atrophy, most prominent in the cerebellum, that were not present on previous scans. The malignancy survey was negative in his case. He failed multiple first line therapies including intravenous immunoglobulin (IVIG) and plasmapheresis with subsequent minimal neurocognitive response to intravenous steroids. However, he responded to Rituximab with significant improvement in cognition but limited improvement in motor skills thus far. We also explore the possible association with recent epidural platelet rich plasma (PRP) therapy treatment.

Design/Methods: NA

Results: NA

Conclusions: NA

Disclosure: Dr. Alani has nothing to disclose. Dr. Rossi has nothing to disclose. Dr. Hoffmann has nothing to disclose. Dr. Benes-Cases has nothing to disclose. Dr. Sharma has nothing to disclose. Dr. Tsakadze has nothing to disclose.

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