Hashimoto Encephalopathy Presenting with Acute Psychosis and Inappropriate Secretion of Antidiuretic Hormone: A Rare Case Responding to Steroid Therapy.

Publisher: International Scientific Information, Inc Country of Publication: United States NLM ID: 101489566 Publication Model: Electronic Cited Medium: Internet ISSN: 1941-5923 (Electronic) Linking ISSN: 19415923 NLM ISO Abbreviation: Am J Case Rep Subsets: MEDLINE

Publication: <2014- > : Smithtown, NY : International Scientific Information, Inc.
Original Publication: Albertson, NY : International Scientific Literature, Inc.

Inappropriate ADH Syndrome*/diagnosis ; Inappropriate ADH Syndrome*/drug therapy ; Inappropriate ADH Syndrome*/etiology ; Brain Diseases*/diagnosis ; Brain Diseases*/drug therapy ; Brain Diseases*/etiology ; Psychotic Disorders*; Male ; Humans ; Aged ; Methylprednisolone/therapeutic use ; Vasopressins

BACKGROUND Hashimoto's encephalopathy (HE) is an autoimmune encephalopathy that can involve various symptoms including psychosis. Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) may be a complication in some neurological diseases. However, the simultaneous occurrence of subacute psychosis and SIADH as the manifestation of HE, observed in the present case, has rarely been reported. CASE REPORT A 72-year-old man was hospitalized with a 4-month history of abnormal behaviors, including talkativeness, stopping consumption of coffee and cigarettes, hoarding garbage, and sleep disorders. On physical examination, increased and incoherent speech with flight of idea and delusion were observed. The Mini-Mental State Examination score was 28/30. Laboratory findings included hyponatremia due to SIADH and a positive result for anti-thyroid and anti-NH2 terminal of alpha-enolase antibodies. Cerebrospinal fluid examination revealed only elevation of IL-6. Brain magnetic resonance imaging was unremarkable; however, (I-123)-iodoamphetamine single-photon emission computed tomography showed extensive hyperperfusion involving the brainstem and bilateral frontal and medial temporal lobes. Electroencephalography showed generalized slow waves, but there were no epileptiform discharges. After 2 courses of high-dose intravenous methylprednisolone followed by oral prednisolone, his symptoms improved. Based on the findings of clinical features and steroid responsiveness, he was diagnosed with HE. Oral prednisolone and antipsychotic drugs were decreased without a relapse and he was discharged to his home. CONCLUSIONS Although psychosis complicating SIADH is rare, HE should be considered in the differential diagnosis because of its treatment efficacy.

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X4W7ZR7023 (Methylprednisolone)
11000-17-2 (Vasopressins)

Hashimoto's encephalitis

Date Created: 20231212 Date Completed: 20231216 Latest Revision: 20231221

20231221

PMC10728882

10.12659/AJCR.942297

38085696