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Fulminant Subacute Sclerosing Panencephalitis Mimicking Autoimmune Encephalitis

Garg, Ravindra Kumar, MD, DM; Kumar, Neeraj, MD, DM; Rizvi, Imran, MD, DM; Pandey, Shweta, MD, DM; Malhotra, Hardeep Singh, MD, DM; Uniyal, Ravi, MD, DM

The Pediatric Infectious Disease Journal: March 2019 - Volume 38 - Issue 3 - p e64
doi: 10.1097/INF.0000000000002148
Letters to the Editor
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Department of Neurology, King George’s Medical University, Uttar Pradesh, India

The authors have no funding or conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.pidj.com).

Address for correspondence: Ravindra Kumar Garg, MD, DM, Department of Neurology, King George’s Medical University, Uttar Pradesh, India. E-mail: garg50@yahoo.com.

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To the Editors:

A 9-year-old boy presented with cognitive decline, after a seizure, of 1-month duration. For 10 days, patient had repeated right focal seizures with altered sensorium. For the last 24 hours, patient had partial status epilepticus (see video, Supplemental Digital Content 1, http://links.lww.com/INF/D229). Patient had altered sensorium. Seizures were controlled, but he failed to regain consciousness. Magnetic resonance imaging brain demonstrated signal changes in left hippocampus, parahippocampal gyrus, and medial temporal lobe (Fig. 1). Cerebrospinal fluid examination was normal. Autoimmune encephalitis was considered.1 Serum and cerebrospinal fluid virology revealed high titers of antimeasles antibodies, and electroencephalography showed periodic discharges. In resource-constrained countries, in such patients, subacute sclerosing panencephalitis should be considered before doing expensive autoimmune antibody profile.2

FIGURE 1

FIGURE 1

Ravindra Kumar Garg, MD, DM

Neeraj Kumar, MD, DM

Imran Rizvi, MD, DM

Shweta Pandey, MD, DM

Hardeep Singh Malhotra, MD, DM

Ravi Uniyal, MD, DM

Department of Neurology

King George’s Medical University

Uttar Pradesh, India

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REFERENCES

1. Graus F, Titulaer MJ, Balu R, et al. A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol. 2016;15:391–404.
2. Garg RK, Malhotra HS, Rizvi I, et al. An unusual case of acute encephalitic syndrome: is it acute measles encephalitis or subacute sclerosing panencephalitis? Neurol India. 2017;65:1333–1344.

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