Seronegative autoimmune encephalitis (AE) is an immune-mediated inflammatory disorder of the central nervous system that presents with a broad spectrum of neuropsychiatric manifestations, including acute behavioral changes, cognitive dysfunction, catatonia, and altered levels of consciousness. The absence of identifiable neuronal autoantibodies in serum or cerebrospinal fluid contributes to diagnostic uncertainty, delayed treatment initiation, and increased morbidity. Given the potential reversibility of this condition, early recognition and prompt initiation of immunotherapy are critical to optimizing clinical outcomes. We report the case of a 68-year-old woman with probable seronegative AE who presented with subacute neuropsychiatric deterioration characterized by prominent psychiatric symptoms and catatonia. An extensive diagnostic evaluation, including cerebrospinal fluid analysis, comprehensive autoimmune antibody testing, and exclusion of infectious, metabolic, and structural etiologies, failed to identify an alternative diagnosis. Functional neuroimaging with 18F-fluorodeoxyglucose positron emission tomography revealed cerebral metabolic abnormalities supportive of an inflammatory encephalitic process. The patient demonstrated marked clinical improvement following early initiation of high-dose intravenous corticosteroid therapy. This case underscores the diagnostic complexity of seronegative AE when neuropsychiatric manifestations predominate and overlap with primary psychiatric disorders. It highlights the importance of maintaining a high index of clinical suspicion despite negative serological findings and supports the use of clinical diagnostic criteria and adjunctive functional neuroimaging to guide early immunotherapeutic intervention in suspected seronegative AE.
Galindo et al. (Mon,) studied this question.