Dados do Trabalho

Título

Hashimoto's Encephalopathy: case report and literature review of a rare entity

RESUMO

Case report
A 62-year-old man presenting altered mental status and a history of four seizure episodes in the past 2 months, along with aggravated neuropsychological symptoms, such as anxiety, delirium, and depression. Previous history of steroid-responsive encephalopathy, suspected Hashimoto’s encephalopathy (HE). He was treated with prednisone 3 months prior current admission, with a gradual withdrawal. Magnetic resonance imaging (MRI) report was unremarkable, serology tests positive for Anti-TPO antibodies, EEG not available. HE suspicion remained. Pulse corticosteroid therapy was administered, previous treatment reinstated.
Discussion
HE is a rare and controversial disease encompassing a heterogeneous neurological and psychological presentation. Diagnosis of HE is a clinical challenge since there isn't a well-defined criteria and the pathophysiological mechanisms are still unclear. Literature review presents neither a gold-standard test for diagnosis nor a reference value for serology exams, although elevated anti-TPO seems to be the hallmark of HE. Other case reports presented highly heterogeneous patient profiles with long-ranging age groups, mostly female, and diverse clinical presentations, varying from acute to insidious onset. Studies showed the relapse and remitting course in 50% of the patients. Most common treatment is still corticosteroid administration, but intravenous immunoglobulin, methotrexate, mycophenolate, and azathioprine have been used with variable efficacies.
Final comments
Thus, it is important to raise awareness of HE since it's a neglected differential diagnosis for various neuropsychological symptoms and early intervention can define prognosis. Furthermore, the relapse after corticosteroids treatment emphasizes the need of therapeutic alternatives, which demands a better understanding of its pathophysiology.

Palavras Chave

Autoimmunity, Encephalopathy, Nervous System Disease