key: cord-1029644-mdgreh0b authors: Torrico, Tyler; Kerr, Wesley T.; DeGiorgio, Christopher M. title: Post-infectious SARS-CoV-2 Autoimmune Encephalitis Associated with N-Type Calcium Channel Antibodies date: 2021-11-09 journal: Neuroimmunology Reports DOI: 10.1016/j.nerep.2021.100039 sha: 13ee4674f24fe8dee3bdae2b679db2e7f0d1e3e1 doc_id: 1029644 cord_uid: mdgreh0b Objective To report the association between SARS-CoV-2 and Anti-N-Type Calcium Channel antibody positive, EEG and MRI-negative encephalitis with a treatment response to plasmapheresis. Background Postinfectious SARS-CoV-2 neuropsychiatric complications are common but the pathogenesis and response to treatment remains poorly understood. Case We report a case of autoimmune encephalitis with subacute onset after SARS-CoV-2infection with positive cerebrospinal fluid serology for Anti-N-Type-Calcium Channel antibodies. CSF profile showed cytoalbuminologic dissociation (CSF WBC 4, Protein 88). MRI and EEG were normal. Plasmapheresis resulted in significant improvement and resolution of cognitive and neuropsychiatric manifestations. Conclusion Anti-N-type-Calcium Channel antibody encephalitis should be considered in patients who develop new neuropsychiatric symptoms after SARS-CoV-2 infection even in absence of positive EEG and MRI findings. SARS-Cov-2 post-infectious autoimmune encephalitis is an evolving condition that has been associated with anti-NMDA receptor, anti-GD1b and anti-Caspr2 antibodies 1 . Psychosis can be the presenting symptom for autoimmune encephalitis no abnormalities on EEG and MRI. Autoimmune encephalitis is treatable but underrecognized, particularly in the post-infectious state of SARS-CoV-2. We report plasmapheresis-responsive postinfectious autoimmune encephalitis after SARS-CoV-2 with anti-N-type calcium channel antibodies in the cerebrospinal fluid (CSF). A 56-year-old Hispanic male with a history of end-stage renal disease, diabetes and hypertension presented for new-onset cognitive decline and hallucinations two months after severe SARS-CoV-2 infection. One week prior to admission, the patient's family reported non-sensical speech, visual and auditory hallucinations and getting lost. History from the patient and family was negative for prior neurological, cognitive, or psychiatric disorders. On admission, vital signs and physical exam were normal. The patient was alert but disoriented to time, date, year, or place. He could not register or recall three words after five minutes and could not perform simple calculations. Speech was tangential. Cranial nerve exam was normal except for prior vision loss bilaterally. We confirm that Drs. Torrico, de Giorgio, and Kerr have full access to all the patient information and the right to publish any and all data separate from any sponsor. Anonymized data not published within this article will be made available by request from any qualified investigator. W Kerr receives research support from NIH R25 NS065723. C DeGiorgio reports support due to an unrestricted grant by the Beverly and James Peters to the UCLA-David Geffen School of Medicine. None. Immune-mediated neurological syndromes in SARS-CoV-2-infected patients A clinical approach to diagnosis of autoimmune encephalitis Rapidly progressive dementiaassociated N-type voltage-gated calcium channel antibody encephalopathy Clinical Presentation and Outcome in Autoimmune Encephalitis Associated With N-Type Voltage-Gated Calcium Channels in Children Autoimmune encephalitis with elevated Ntype calcium channel antibodies presenting as psychotic depression How SARS-CoV-2 Affects the Brain Autoimmune and inflammatory diseases following SARS-CoV All authors contributed to writing the manuscript. Our local IRB and ethical standards committee does not review case reports as they are observational reports only. The patient consented to permission for publication and this is on file by request. Written informed consent-to-disclose from the patient was obtained.