ArticleFrontiers in immunology2026
Case Report: Anti-GABA-B receptor encephalitis with refractory status epilepticus and favorable short-term recovery.
Article in Frontiers in immunology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Anti-gamma-aminobutyric acid type B receptor (anti-GABA-B receptor) encephalitis is a rare autoimmune limbic encephalitis that frequently presents with seizures and may be associated with malignancy, most commonly small-cell lung cancer. We report a 66-year-old man with anti-GABA-B receptor encephalitis who presented with a witnessed generalized tonic-clonic seizure after a 2-day prodrome of nocturnal repetitive stereotyped behaviors retrospectively suspicious for subtle focal seizures with automatisms. Brain magnetic resonance imaging showed right-predominant hippocampal and multifocal cortical hyperintensities, and cerebrospinal fluid analysis showed mild pleocytosis and elevated protein with negative infectious testing. He deteriorated on hospital day 5 with refractory status epilepticus and hypoxemic respiratory failure requiring intubation and intensive care. Anti-GABA-B receptor antibodies were subsequently confirmed in both serum and cerebrospinal fluid. Initial malignancy evaluation included contrast-enhanced computed tomography of the chest, abdomen, and pelvis; serum tumor markers; and an onconeural antibody panel. No malignancy was detected. Treatment included intravenous methylprednisolone, 10 sessions of therapeutic plasma exchange, and multi-agent antiseizure therapy. He was extubated after approximately 2 weeks and discharged on hospital day 39 with a modified Rankin Scale score of 3. At 3 months, he was seizure-free, with a modified Rankin Scale score of 1, a Barthel Index of 95/100, and a Mini-Mental State Examination score of 30/30. This single uncontrolled case is hypothesis-generating and does not establish treatment efficacy, optimal plasma exchange duration, long-term prognosis, or definitive non-paraneoplastic status. It illustrates that new-onset refractory status epilepticus should prompt expedited autoimmune encephalitis evaluation and that structured oncologic surveillance remains necessary despite negative initial tumor screening.
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