A 59-year-old woman presented to the hospital with acute, hypoactive altered mental status. Her symptoms had begun 3 days prior when she developed hallucinations, urinary and faecal incontinence, and somnolence. She also exhibited confabulations, amnesia, motor memory loss and a wide-based gait. Medical, psychiatric and neurological evaluations including imaging and laboratory workup were unrevealing. Treatment for possible Wernicke encephalopathy and psychosis with high-dose intravenous thiamine and antipsychotic medications did not lead to improvement. After discharge, a send-out cerebrospinal fluid autoimmune encephalitis panel resulted positive for the newly identified neuronal inositol triphosphate receptor one (ITPR1) antibody. This prompted readmission for intravenous steroids, plasmapheresis and intravenous immunoglobulin, which yielded mild clinical improvement. Here, we describe confabulations and psychiatric symptoms as novel manifestations of the primary presentation of anti-ITPR1 encephalitis in an effort to promote faster recognition of this disease and early initiation of treatment in suspected cases.
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JRS and BPF are joint first authors.
JRS and BPF contributed equally.
Contributors JRS and BPF planned, designed and wrote the case report as co-lead authors with support from RS, TLH, JKG and LMG. In particular, the latter four authors provided additional references and gave significant feedback for each section of the paper to present this final version. All authors were involved in the care of this patient and thus were able to provide insight into key components of research, background, case information and clinical trajectory. All authors made significant contributions to writing and editing each section for content, grammar, flow and accuracy. Co-lead authors incorporated all suggestions and coordinated the efforts of the other authors. Furthermore, the authors all reviewed and interpreted the relevant research to best determine which content to incorporate into the report to make a contribution to medical literature in this topic area.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.