An unusual presentation of autoimmune encephalitis: a potentially dangerous clinical challenge

Introduction: Cases of immune-mediated encephalitis are rare: in literature, there are case reports and prospective studies involving a limited number of patients. Material and method: We describe the case of a young woman presenting in the emergency department after having visited two other hospitals for new-onset seizure-like focal neurological symptoms associated with fever. Only the patient and her parents witnessed these symptoms. Evaluated in the emergency department and subsequently hospitalized in the suspicion of meningoencephalitis of infectious origin, the patient underwent numerous laboratory and diagnostic tests that excluded said origin. Antiepileptic therapy with levetiracetam was set up. Given the young age of the patient and the female gender, the immune-mediated origin was considered, and high-dose corticosteroid therapy was initiated with progressive improvement of the clinical picture. The patient has been discharged from the Neurology service with indications to continue the antiepileptic therapy, and was organized a follow-up as an outpatient. Result and conclusion: The purpose of this report is to raise awareness among physicians on the importance of not underestimating neurological symptoms described but not observed at the time of the visit. They can be well described by the patient or by those accompanying him/her, and it is essential to pay attention to any changes in the normal state of the patient they may have noticed, even when they are perceived as disproportionally apprehensive.