Serological tests for autoimmune diseases including anti-nuclear antibodies, anti-aquaporin 4 antibodies, anti-SS-A/-B antibodies, and anti-glycolipid (GM1, GQ1b) antibodies were negative. Serological tests for systemic infection including procalcitonin, (1→3)-β-D-glucan, human immunodeficiency virus, cytomegalovirus (CMV), and Epstein-Barr virus (EBV) were negative. One hour after hospitalization, she developed persistent generalized tonic-clonic seizures, resulting in emergent intubation and mechanical ventilation in the intensive care unit.Ī routine blood analysis showed a normal leukocyte count, thyroid function, creatine phosphokinase, and C-reactive protein levels. She presented with ocular flutter, muscle stiffness and rigidity of limbs, myoclonus around the mouth and abdomen, dysuria, and brisk tendon reflexes with no pathological reflex. In her neurological examination, the Glasgow Coma Scale was E2V1M4. On admission, she had a mild fever (axillary body temperature, 37.5☌) and occasionally showed sinus bradycardia (minimum heart rate: 34 beats per minute). On day 17, she was transferred to our hospital with a progressively impaired consciousness. She was treated with meropenem (3 g/day), acyclovir (1,500 mg/day), and dexamethasone (19.8 mg/day) as she was suspected to have encephalitis. A cerebrospinal fluid (CSF) analysis revealed an elevated cell count (58 cells/μL), high protein (127.0 mg/dL), and normal levels of glucose (82 mg/dL) on day 15. Brain magnetic resonance imaging (MRI) showed normal findings on day 14. At the time, she presented with disorientation, nystagmus, a limitation of abduction of the left eye, rigidity in the right limb, dysuria, and paralysis of both upper limbs. Walking difficulties related to stiffness and bradykinesia appeared on day 12. In addition, since she suffered from dysphagia and had difficulty eating, she was admitted to the previous hospital on day 10. She presented with hearing loss and enteritis-like symptoms such as fever, vomiting, and diarrhea on day 5. She had a past medical history of congenital hip dysplasia after bilateral hip replacement, had no particular family history, and took no medications. A 59-year-old Japanese woman developed a problem with writing due to tremors in her fingers on the first day of symptom onset (day 1).
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December 2022
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