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Case Reports in Neurological Medicine
Volume 2017, Article ID 3790741, 4 pages
https://doi.org/10.1155/2017/3790741
Case Report

Steroid-Responsive Encephalopathy Associated with Autoimmune Thyroiditis Presenting with Fever and Confusion

1Department of Pharmacology, Faculty of Medicine, University of Colombo, No. 25, Kinsey Road, Colombo, Sri Lanka
2National Hospital of Sri Lanka, E. W. Perera Mawatha, Colombo 07, Sri Lanka

Correspondence should be addressed to Chiranthi Kongala Liyanage; moc.liamg@eganayilihtnarihc

Received 21 August 2017; Accepted 23 October 2017; Published 6 November 2017

Academic Editor: Peter Berlit

Copyright © 2017 Chiranthi Kongala Liyanage et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Steroid-Responsive Encephalopathy Associated with Autoimmune Thyroiditis (SREAT) is a diagnostic conundrum as it may present with a myriad of nonspecific clinical features and laboratory and neuroimaging investigations are not diagnostic. We report a case of a 65-year-old female who presented with an acute febrile illness associated with headache and confusion, tangential thoughts, and loose association. Based on neutrophil leukocytosis in the full blood count and elevated inflammatory markers, she was commenced on empirical intravenous antibiotics suspecting meningoencephalitis. Further evaluation found a very high titer of both anti-thyroid peroxidase (anti-TPO) antibodies and anti-thyroid globulin antibodies. She was clinically and biochemically euthyroid. EEG showed right sided frontal intermittent rhythmic delta activity (FIRDA). Cranial MRI revealed age related cerebral atrophy and nonspecific periventricular white matter changes. A diagnosis of SREAT was made and she was treated with intravenous methylprednisolone followed by oral prednisolone. Her condition improved dramatically within 48 hours of starting steroids. SREAT is a diagnosis of exclusion in patients with a central nervous system disorder. There are no specific clinical features or investigative findings. Elevated anti-TPO antibodies are considered a hallmark of SREAT and steroid responsiveness supports the diagnosis. Prompt diagnosis and treatment reverses the neurological dysfunction in most cases.