Type 1 diabetes and GAD65 limbic encephalitis: a case report of a 10-year-old girl.
Limbic encephalitis is a rare neurological disorder that may be difficult to recognize. Clinical features include memory impairment, temporal lobe seizures and affective disturbance. We report the case of a 10-year-old girl with type 1 diabetes mellitus that presented with seizures, depressed mood and memory changes. The diagnosis of glutamic acid decarboxylase 65 (GAD65) mediated limbic encephalitis relied on cerebral magnetic resonance imaging lesions and high serological and cerebrospinal fluid GAD65-antibodies titers. High-dose steroidal therapy was started with clinical improvement. Relapse led to a second high-dose steroid treatment followed by rituximab with remission. A correlation between serum GAD65-antibodies levels and symptoms was found, demonstrating GAD65-antibodies titers may be useful for clinical follow-up and immunotherapy guidance. This report raises awareness of this serious neurological condition that may be associated with type 1 diabetes, underlining the importance of an early diagnosis and prompt treatment for a better prognosis.
Ema
E
Grilo
Joana
J
Pinto
Joana Serra
JS
Caetano
Helena
H
Pereira
Patrícia
P
Cardoso
Rita
R
Cardoso
Isabel
I
Dinis
Cristina
C
Pereira
Isabel
I
Fineza
Alice
A
Mirante
D001323:Autoantibodies / Q000097:blood*; D015415:Biomarkers / Q000097:blood*; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000201:enzymology; D005260:Female; D005968:Glutamate Decarboxylase / Q000276:immunology*; D006801:Humans; D020363:Limbic Encephalitis / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D011379:Prognosis
D001323:Autoantibodies; D015415:Biomarkers; D005968:Glutamate Decarboxylase; C401141:glutamate decarboxylase 2