title: Infectious disease or Hashimoto's encephalopathy flares: a case report.
abstract: Hashimoto's encephalopathy is an under-recognized and rare disease that presents a diagnostic conundrum since many features are suggestive of infectious etiologies and yet treatment is immunosuppressive medications. We describe a case of a male with a history of recurrent seizures who presented with a subacute onset of confusion, persistent leukocytosis and fever while on immunosuppressant therapy, whose response to high dose steroids was incomplete and who achieved a complete remission of all symptoms when plasmapheresis was initiated. A negative cerebrospinal fluid (CSF) and serum microbiological testing in a patient with an abnormal EEG, increased CSF protein, and elevated thyroid antibodies should prompt consideration of Hashimoto's encephalopathy. If after treating with high dose steroids, there is a sub-optimal clinical response, plasmapheresis should be considered.
authors.affiliation: Department of Medicine, Greater Baltimore Medical Center, Baltimore, MD 21204, USA.
authors.forename: Wenyan
authors.initials: W
authors.lastname: Huang
authors.forename: Chang
authors.initials: C
authors.lastname: Xia
authors.forename: Marie
authors.initials: M
authors.lastname: Chatham
mesh_terms: D001927:Brain Diseases / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000628:therapy*; D003937:Diagnosis, Differential; D004660:Encephalitis; D050031:Hashimoto Disease / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007239:Infections / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis / Q000379:methods; D012008:Recurrence
chemical_list: D007166:Immunosuppressive Agents