case_images: PMC11746041_01
case_images: Patient's physical examination results. (A) hair loss and upper body forward leaning due to torso stiffness; (B) multiple patchy vitiligo.
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case_images: During the disease course, the patient has experienced consciousness disorders, involuntary limb shaking, frothing at the mouth, trunk stiffness leading to a hunchback ( Figure 1A ), and lower back and abdominal pain. The patient experienced hair loss in 2006, currently resulting in sparse hair ( Figure 1A ). He developed vitiligo in 2007, which remains untreated ( Figure 1B ).
case_images: 19 CSF autoimmune-related antibody tests showed positive results for anti-GAD65 antibody, while the rest were negative. NMDAR, N-methyl-D-aspartate receptor; AMPAR1, alpha-Amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor 1; AMPAR2, alpha-Amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor 2; LGI1, leucine-rich glioma inactivated 1; CASPR2, contactin-associated protein 2; GABABR,gamma-Aminobutyric acid type B receptor; GABAARalpha1: gamma-Aminobutyric acid A receptor alpha 1; GABAARbeta3: gamma-Aminobutyric acid A receptor beta 3; GABAARgamma2: gamma-Aminobutyric acid A receptor gamma 2; mGluR5, metabotropic Glutamate receptor 5; GlyRalpha1, Glycine receptor alpha 1; GAD65, glutamic acid decarboxylase 65; MOG, myelin oligodendrocyte glycoprotein; GFAP, glial fibrillary acidic protein; HuB, anti-neuronal nuclear antibody type-1B; HuC, anti-neuronal nuclear antibody type-1C; HuD, anti-neuronal nuclear antibody type-1D; CRMP5, collapsing response mediator proteins 5.
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case_images: Cerebrospinal fluid (CSF) autoimmune-related antibody tests showed positive results for anti-GAD65 antibody ( Figure 2 ).
case_images: Resting potential electromyographic findings of the paraspinal muscles after intravenous injection of diazepam.
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case_images: After 3 minutes, the action potential significantly decreased, and after 5 minutes, it significantly decreased but did not completely disappear ( Figure 3 ).
case_images: Video electroencephalography after treatment with additional IVIG.
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case_images: Epileptic seizures did not recur within this period, and a video electroencephalogram (VEEG) indicated mild abnormalities without epileptic discharge ( Figure 4 ).