Limbic Encephalitis following Guillain-Barré Syndrome Associated with Mycoplasma Infection
2019
A 12-year-old girl was admitted to the authors’ hospital due to muscle weakness, gait disturbance,
dysarthria, dysphagia, and
diplopia. She experienced
prodromalfever 10 days before admission. On examination,
deep tendon reflexwas absent in the extremities, and
nerve conduction velocitywas decreased in the
ulnar nerve. She was diagnosed with
Guillain-Barre syndrome(GBS). Despite steroid pulse therapy following administration of intravenous high-dose γ-globulin, clinical manifestations remained unchanged. Therefore, plasma exchange was performed on day 10 of the illness. The titer of serum
Mycoplasma
immunoglobulin Mlevel was increased. Immunological testing was positive for serum anti-
galactocerebrosideC antibody. On day 18 of the illness, however, she developed generalized convulsion. Brain magnetic resonance imaging revealed high intensity in the medial temporal lobes, including the hippocampus and thalamus on T2-weighted intensity imaging, which was consistent with
limbic encephalitis. Further immunological tests revealed positivity for anti-N-methyl-D-aspartate-type glutamate receptor antibody in the cerebrospinal fluid. She was treated with additional plasma exchange; however, she exhibited residual manifestations including short-term
memory disorder, emotional incontinence, and convulsions. This article describes a notable case of
limbic encephalitisfollowing GBS associated with
prodromal
Mycoplasmainfection. It is interesting that autoimmune encephalopathy is concomitant with autoimmune
polyneuropathysubsequent to
Mycoplasmainfection.
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