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Anti-CASPR2 encephalitis in a liver posttransplant patient receiving immune-suppression and lenvatinib: a case report and literature review

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Abstract

It has been assumed that patients with strict immunosuppressive treatment after solid organ transplantation have only marginal risk in developing autoimmune encephalitis. We reported a woman in her late 40 s who presented with generalized convulsions and loss of consciousness. After detailed history review, neuropsychological tests, metagenomic next-generation sequencing of serum and cerebrospinal fluid (CSF), magnetic resonance imaging (MRI) brain, and electroencephalogram, she was diagnosed as anti-CASPR2 encephalitis based on the positive anti-CASPR2 auto-antibody in serum and CSF. The patient underwent liver transplantation and has taken lenvatinib for 2 months, in addition to tacrolimus, mycophenotale mofetil, and entecavir administered for half a year. This case was the first report of anti-CASPR2 encephalitis in post–organ transplantation patients. Together with the reports of other encephalitis cases in organ transplantation, it warns the possibility of developing immune-oriented encephalitis in patients undergoing immunosuppression, especially in combination with other treatments of immunomodulatory activity.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. Graus F, Titulaer MJ, Balu R, Benseler S, Bien CG, Cellucci T, Cortese I, Dale RC, Gelfand JM, Geschwind M, Glaser CA, Honnorat J, Höftberger R, Iizuka T, Irani SR, Lancaster E, Leypoldt F, Prüss H, Rae-Grant A, Reindl M, Rosenfeld MR, Rostásy K, Saiz A, Venkatesan A, Vincent A, Wandinger KP, Waters P, Dalmau J (2016) A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol 15:391–404

    Article  PubMed  PubMed Central  Google Scholar 

  2. Ahmadinejad Z, Talebi F, Yazdi NA, Ghiasvand F (2019) A 41-year-old female with progressive multifocal leukoencephalopathy after liver transplant. J Neurovirol 25:605–607

    Article  PubMed  Google Scholar 

  3. Pruitt AA (2017) Neurologic complications of transplantation Continuum (Minneap Minn) 23:802–821

    PubMed  Google Scholar 

  4. Phan TL, Lautenschlager I, Razonable RR, Munoz FM (2018) HHV-6 in liver transplantation: a literature review. Liver Int 38:210–223

    Article  PubMed  Google Scholar 

  5. Cohen DA, Lopez-Chiriboga AS, Pittock SJ, Gadoth A, Zekeridou A, Boilson BA, Hogan WJ, Poterucha JJ, Wilton KM, Lin Y, Flanagan EP (2018) Posttransplant autoimmune encephalitis Neurol Neuroimmunol Neuroinflamm 5:e497

    Article  PubMed  Google Scholar 

  6. Randall A, Huda S, Jacob A, Larner AJ (2018) Autoimmune encephalitis (NMDAR antibody) in a patient receiving chronic post-transplant immunosuppression. Pract Neurol 18:320–322

    Article  PubMed  Google Scholar 

  7. Konen FF, Schwenkenbecher P, Jendretzky KF, Hümmert MW, Wegner F, Stangel M, Sühs KW, Skripuletz T (2019) Severe anti-N-methyl-D-aspartate receptor encephalitis under immunosuppression after liver transplantation. Front Neurol 10:987

    Article  PubMed  PubMed Central  Google Scholar 

  8. Wang P, Zheng SG (2013) Regulatory T cells and B cells: implication on autoimmune diseases. Int J Clin Exp Pathol 6:2668–2674

    PubMed  PubMed Central  Google Scholar 

  9. Zhu J, Fang P, Wang C, Gu M, Pan B, Guo W, Yang X, Wang B (2021) The immunomodulatory activity of lenvatinib prompts the survival of patients with advanced hepatocellular carcinoma. Cancer Med 10:7977–7987

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Dubey D, Britton J, McKeon A, Gadoth A, Zekeridou A, Lopez Chiriboga SA, Devine M, Cerhan JH, Dunlay K, Sagen J, Ramberger M, Waters P, Irani SR, Pittock SJ (2020) Randomized placebo-controlled trial of intravenous immunoglobulin in autoimmune LGI1/CASPR2 epilepsy. Ann Neurol 87:313–323

    Article  CAS  PubMed  Google Scholar 

  11. Gaspard N (2020) An eye for an eye: a randomized placebo-controlled trial of IVIG in antibody-mediated encephalitis. Epilepsy Curr 20:138–140

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

This study was supported by the Hospital Management Fund of Sichuan Provincial People’s Hospital (2021481).

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Author notes

  1. Duo-Zi Wang and Bing-Hu Li contributed equally to this paper.

Authors and Affiliations

  1. Department of Neurology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China

    Duo-Zi Wang, Bing-Hu Li, Bin-Lu Deng, Fu-Qiang Guo, Shan-Shan Hu, Neng-Wei Yu & Jie Liu

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  1. Duo-Zi Wang
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  2. Bing-Hu Li
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  7. Jie Liu
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Contributions

NWY and JL designed the study. BLD and SSH collected data. DZW, BHL, FQG, and JL drafted the manuscript. All authors critically revised, read, and approved the final manuscript.

Corresponding authors

Correspondence to Neng-Wei Yu or Jie Liu.

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The participant as well as her family has consented to the publication of the case report to the journal.

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Wang, DZ., Li, BH., Deng, BL. et al. Anti-CASPR2 encephalitis in a liver posttransplant patient receiving immune-suppression and lenvatinib: a case report and literature review. Neurol Sci 44, 1069–1072 (2023). https://doi.org/10.1007/s10072-022-06560-4

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  • DOI: https://doi.org/10.1007/s10072-022-06560-4

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