Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2022 Aug 30:13:970448.
doi: 10.3389/fimmu.2022.970448. eCollection 2022.

Case Report: Possible autoimmune obsessive-compulsive disorder with postpartum onset

Dominique Endres  1 , Luciana Hannibal  2 , Benjamin Zaltenbach  1 , Miriam A Schiele  1 , Kimon Runge  1 , Kathrin Nickel  1 , Benjamin Berger  3   4 , Katharina Domschke  1   5 , Nils Venhoff  6 , Harald Prüss  7   8 , Ludger Tebartz van Elst  1
Affiliations
Case Reports

Case Report: Possible autoimmune obsessive-compulsive disorder with postpartum onset

Dominique Endres et al. Front Immunol. .

Abstract

Autoimmune obsessive-compulsive disorder (OCD) is rare. The case presented here is that of a female patient in her mid-thirties who developed postpartum OCD. Magnetic resonance imaging showed multiple juxtacortical hyperintensities that may have been post-inflammatory in origin. In tissue-based assays using mouse brain slices, the patient's cerebrospinal fluid (CSF) showed novel anti-nucleoli autoantibodies in cerebellar Purkinje cells and cortical neurons. The CSF dopamine and glutamate concentrations were dysregulated. The clinical course and diagnostic findings were compatible with possible autoimmune OCD with postpartum onset.

Keywords: CSF; autoantibody; autoimmune OCD; cerebrospinal fluid; postpartum.

PubMed Disclaimer

Conflict of interest statement

KD: Steering Committee Neurosciences, Janssen. LT: Advisory boards, lectures, or travel grants within the last three years: Roche, Eli Lilly, Janssen-Cilag, Novartis, Shire, UCB, GSK, Servier, Janssen and Cyberonics. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Magnetic resonance imaging (MRI), neuropsychological, [18F]fluorodeoxyglucose positron emission tomography (FDG-PET), cerebrospinal fluid (CSF), and electroencephalography (EEG) findings. Additional investigations, including independent component analysis of the EEG and optical coherence tomography, identified no specific changes (data not shown). CSF, cerebrospinal fluid; GM, grey matter, L, left; R, right; ROI, region of interest. (A) MRI demonstrated multiple punctate FLAIR hyperintense white matter lesions, predominantly subcortical changes. (B) The neuropsychological testing, including a test battery for attention performance (“TAP”) and the verbal learning and memory test (“VLMT”) identified mostly normal results, only the divided attention showed below average findings. (C) FDG-PET of the brain showed normal findings. The globally normalized FDG image is shown. FDG-PET of the whole body showed no evidence of tumor (not shown). (D) Autoantibody staining using tissue-based assays on murine brain identified highly positive autoantibodies against nucleoli in CSF (left in cortex, right in cerebellar Purkinje cells [arrows]). (F) A combined volume-based and region-based analysis method using the MPRAGE MRI images identified no atrophic changes (https://www.veobrain.com/?page=veomorph). (E) EEG detected normal findings.
See this image and copyright information in PMC

References

    1. Swedo SE, Leonard HL, Mittleman BB, Allen AJ, Rapoport JL, Dow SP, et al. . Identification of children with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections by a marker associated with rheumatic fever. Am J Psychiatry (1997) 154(1):110–2. doi: 10.1176/ajp.154.1.110 - DOI - PubMed
    1. Endres D, Mertens L, Berger B, Reisert M, Runge K, Nickel K, et al. . Autoimmune obsessive-compulsive disorder with novel anti-basal ganglia antibodies. Psychother Psychosom (2022) 21:1–3. doi: 10.1159/000522136 - DOI - PubMed
    1. Endres D, Pollak TA, Bechter K, Denzel D, Pitsch K, Nickel K, et al. . Immunological causes of obsessive-compulsive disorder: is it time for the concept of an "autoimmune OCD" subtype? Transl Psychiatry (2022) 12(1):5. doi: 10.1038/s41398-021-01700-4 - DOI - PMC - PubMed
    1. Endres D, Matysik M, Feige B, Venhoff N, Schweizer T, Michel M, et al. . Diagnosing organic causes of schizophrenia spectrum disorders: Findings from a one-year cohort of the freiburg diagnostic protocol in psychosis (FDPP). Diagnostics (Basel) (2020) 10(9):691. doi: 10.3390/diagnostics10090691 - DOI - PMC - PubMed
    1. Prüss H. Autoantibodies in neurological disease. Nat Rev Immunol (2021) 11:1–16. doi: 10.1038/s41577-021-00543-w - DOI - PMC - PubMed

Publication types