Probable Autoimmune Depression in a Patient With Multiple Sclerosis and Antineuronal Antibodies

Dominique Endres; Sebastian Rauer; Nils Venhoff; Patrick Süß; Rick Dersch; Kimon Runge; Bernd L Fiebich; Kathrin Nickel; Miriam Matysik; Simon Maier; Katharina Domschke; Karl Egger; Harald Prüss; Ludger Tebartz van Elst

doi:10.3389/fpsyt.2020.00745

Probable Autoimmune Depression in a Patient With Multiple Sclerosis and Antineuronal Antibodies

Front Psychiatry. 2020 Aug 13:11:745. doi: 10.3389/fpsyt.2020.00745. eCollection 2020.

Authors

Dominique Endres^{1

2}, Sebastian Rauer³, Nils Venhoff⁴, Patrick Süß⁵, Rick Dersch³, Kimon Runge^{1

2}, Bernd L Fiebich², Kathrin Nickel^{1

2}, Miriam Matysik^{1

2}, Simon Maier^{1

2}, Katharina Domschke^{2

6}, Karl Egger⁷, Harald Prüss^{8

9}, Ludger Tebartz van Elst^{1

2}

Affiliations

¹ Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
² Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
³ Department of Neurology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
⁴ Department of Rheumatology and Clinical Immunology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
⁵ Department of Molecular Neurology, University Hospital Erlangen, Erlangen, Germany.
⁶ Center for Basics in Neuromodulation, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
⁷ Department of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
⁸ Department of Neurology and Experimental Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
⁹ German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany.

Abstract

Background: In a subgroup of patients with mood disorders, clear-cut organic disorders are responsible for depressive symptoms (e.g., autoimmune diseases such as multiple sclerosis or systemic lupus erythematosus). In these cases, an organic affective disorder can be diagnosed.

Case presentation: The authors present the case of a 59-year-old male patient who developed a severe depressive episode over approximately 6 months and was, therefore, admitted to the hospital. In retrospect, he reported that, at age 39, he suffered from self-limiting sensory disturbances and muscle weakness in both legs. The current magnetic resonance imaging of his brain showed several conspicuous FLAIR-hyperintense supratentorial white matter lesions compatible with chronic inflammatory brain disease. Imaging of the spinal axis revealed no clear spinal lesions. Cerebrospinal fluid (CSF) analyses showed CSF-specific oligoclonal bands. Therefore, multiple sclerosis was diagnosed. Further CSF analyses, using tissue-based assays with indirect immunofluorescence on unfixed murine brain tissue, revealed a (peri-)nuclear signal and a strong neuritic signal of many neurons, especially on granule cells in the cerebellum, hippocampus, and olfactory bulb, as well as in the corpus callosum. Additionally, antinuclear antibody (ANA) titers of 1:12,800 and a lymphopenia were detected in blood tests. Further system clarification showed no suspicion of rheumatic or oncological disease. Anti-inflammatory treatment led to rapid and sustained improvement.

Conclusion: The present patient suffered from a probable "autoimmune depression" in the context of newly diagnosed multiple sclerosis with typical MRI and CSF pathologies, alongside mild concomitant latent systemic autoimmune process (with high-titer ANAs and lymphopenia) and unknown antineuronal antibodies. The case report illustrates that a depressive syndrome suggestive of primary idiopathic depressive disorder may be associated with an autoimmune brain involvement. The detection of such organic affective disorders is of high clinical relevance for affected patients, as it enables alternative and more causal treatment approaches.

Keywords: autoantibody; autoimmune encephalitis; connective tissue disease; depression; multiple sclerosis.

Publication types

Case Reports