Mistake in diagnosis, Unusual or unexpected effect of treatment, Patient complains / malpractice, Rare disease
Lei He, Mei Li, Xiao-Hong Long, Xiang-Pen Li, Ying Peng
Guangzhou, China (mainland)
Am J Case Rep 2013; 14:366-369
Available online: 2013-09-13
Background: Hashimoto’s encephalopathy is a rare autoimmune syndrome characterized by various neuropsychiatric or neurological manifestations and associated with Hashimoto’s thyroiditis, responsive to steroids. Until now, misdiagnosis and delay of treatment of Hashimoto’s encephalopathy are very common because of the diversity of the symptoms.
Case Report: This recent case of a 61-year-old man presented with unconsciousness, spasms and a previous misdiagnosis as viral encephalitis. Response to anti-viral and steroid therapy was unsatisfactory, but treatment with immunoglobulin combined with corticosteroid therapy achieved rapid and complete recovery.
Conclusions: Any patient presenting with acute or subacute unexplained encephalopathy should be considered Hashimoto’s encephalopathy, even if the thyroid function is normal. Thyroid antibody testing should be performed because this may be the most important clue to diagnosis. As soon as the diagnosis is made, steroid therapy is the first choice. If the steroid therapy does not lead to immediate improvement, IVIG is an effective alternative treatment.
Keywords: Hashimoto’s thyroiditis, corticosteroids, antithyroid antibodies, intravenous immunoglobulins, Hashimoto’s encephalopathy