title: Autoimmune Encephalitis Following Bone Marrow Transplantation.
abstract: BACKGROUND
  Neurological complications, especially encephalopathy and seizures, are commonly seen in bone marrow transplant patients. Infections, chemotoxicity, graft versus host disease, or secondary central nervous system malignancies are the most common underlying etiologies. There is increased awareness that autoimmune encephalitis may cause neurological dysfunction in immunocompetent children. The potential role of such a mechanism in children undergoing bone marrow transplantation is unknown.
  
  
  METHODS
  We report a boy who developed autoimmune encephalitis with voltage-gated potassium channel-associated and thyroid autoantibodies subsequent to transplantation.
  
  
  RESULTS
  A 7-year-old boy presented with a change in behavior, poor attention, cognitive deficits, and abnormal movements 15 months after undergoing transplantation for idiopathic aplastic anemia. He had clinical and subclinical seizures and brain magnetic resonance imaging hyperintensities bilaterally in the uncal regions. His evaluation revealed high titers of voltage-gated potassium channel, leucine-rich glioma-inactivated 1 protein, and thyroglobulin antibodies suggestive of autoimmune limbic encephalitis. He showed significant improvement in behavior and neuropsychological testing and has remained seizure-free on levetiracetam after immunotherapy with corticosteroids and intravenous immunoglobulin.
  
  
  CONCLUSIONS
  Systemic autoimmune manifestations in bone marrow transplant patients have been well-documented, but autoimmune encephalitis after transplantation has yet to be described in children.
authors.affiliation: Department of Neurology and Developmental Neuroscience, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas. Electronic address: grathore@bcm.edu.
authors.forename: Geetanjali S
authors.initials: GS
authors.lastname: Rathore
authors.affiliation: Department of Pediatrics, Section of Hematology-Oncology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
authors.forename: Kathryn S
authors.initials: KS
authors.lastname: Leung
authors.affiliation: Department of Pediatric Medicine, Sections of Immunology, Allergy & Rheumatology and Child Neurology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
authors.forename: Eyal
authors.initials: E
authors.lastname: Muscal
mesh_terms: D000741:Anemia, Aplastic / Q000601:surgery; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D001921:Brain / Q000473:pathology; D002648:Child; D003937:Diagnosis, Differential; D004660:Encephalitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D050031:Hashimoto Disease / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male
keywords: Hashimoto encephalopathy; autoimmune epilepsy; cognitive changes in bone marrow transplant patients; leucine-rich glioma-inactivated 1 protein (LGI1); limbic encephalitis; voltage-gated potassium channel (VGKC) associated antibody