Abstract
Anti-Iglon-5 disease has wide array of manifestations.1 Those can range from sleep disorders with parasomnia, PSP-like presentations, cognitive decline, bulbar dysfunction, or movement disorders.2
We present 3 cases of Anti-Iglon-5 encephalitis where patients had variable presentations demonstrating the heterogeneity of the condition. Iglon-5 antibodies were confirmed in each case.
A 62-year-old woman with a past medical history of obstructive sleep apnoea presented with Type 2 Respiratory failure requiring intubation. She failed multiple attempts at extubation and required a tracheostomy indefinitely, leading to a diagnosis of Anti-Iglon-5 encephalitis. She also was fitted with a gastrostomy tube due to persistent dysphagia. She was treated with steroids and rituximab.
A 71-year-old woman had a paraneoplastic Anti-Iglon-5 encephalitis when she presented with a subacute and progressive lower limb apraxia in the setting of metastatic breast cancer. Her cancer was advanced, and she was not longer a candidate for systemic therapy.
A 76-year-old man presented with an acute right middle cerebral artery occlusion requiring endovascular thrombectomy. He was recovering from the stroke when his rehabilitation became challenged by long periods of obtundation and apnoea averaging 20 seconds. He was subsequently diagnosed with an Iglon-5 antibody. He failed to respond to steroids.
Those cases highlight the need to recognise the various presentations of Anti-Iglon-5 encephalitis, such that prompt evaluation and treatment are initiated.
References
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Werner J, Jelcic I, Schwarz EI, Probst-Müller E, Nilsson J, Schwizer B, Bloch KE, Lutterotti A, Jung HH, Schreiner B. Anti-IgLON5 Disease: A New Bulbar-Onset Motor Neuron Mimic Syndrome. Neurol Neuroimmunol Neuroinflamm. 2021 Feb 2;8(2):e962. doi: 10.1212/NXI.0000000000000962. PMID: 33531378; PMCID: PMC8057065.
