Anti-α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR) encephalitis is a rare, often paraneoplastic, cause of limbic encephalitis. The concurrent presentation of anti-AMPAR encephalitis alongside multiple autoimmune syndromes and antibodies is exceedingly uncommon. We describe a 62-year-old man with no significant past medical history who presented with a rapidly progressive 4-month history of cognitive decline and gait disturbance. Comprehensive evaluation revealed anti-AMPAR encephalitis, thymoma, subclinical myasthenia gravis, and autoimmune thyroiditis, demonstrating coexistence of multiple autoimmune disorders. Immunological assessment identified a complex polyspecific autoantibody profile, including anti-AMPAR2, anti-Titin, anti-glutamic acid decarboxylase 65, anti-anti-acetylcholine receptor, and anti-thyroid antibodies. Following aggressive immunotherapy and thymectomy, the patient experienced substantial neurological improvement. Anti-AMPAR encephalitis can coexist with multiple autoimmune disorders and diverse autoantibodies. Therefore, thorough antibody screening and tumor evaluation are essential to identify occult etiologies and to guide optimal therapeutic strategies.
Plasmapheresis has been proven to be highly beneficial in managing acute attacks of neuromyelitis optica spectrum disorder (NMOSD). Depending on vascular availability, plasmapheresis can be performed through peripheral or central venous access. Rare complications can occur during insertion, maintenance, and removal of the catheter. We report a case of cerebral air embolism occurring following the removal of a double-lumen catheter used for plasmapheresis in a patient with NMOSD.
