Case report: Anti-GAD65 antibody-associated autoimmune encephalitis following HPV vaccination

Abstract

Human papillomavirus (HPV) infection is a sexually transmitted disease that may lead to cervical cancer. HPV vaccines have been implemented widely to prevent this. While generally few complications of vaccination are reported, there have been occasional reports of adverse reactions post-vaccination. The safety profile of the HPV vaccine is reassuring. However, since its introduction, several serious post-vaccination central nervous system complications have been reported; however, causality has not been established. Herein, we describe a 39-year-old woman who developed seizures and experienced a rapid decline in memory shortly after her first dose of the HPV vaccine. Cranial magnetic resonance imaging and cerebrospinal fluid analysis were performed, and the patient was diagnosed with anti-glutamic acid decarboxylase 65 (anti-GAD65) antibody-associated autoimmune encephalitis. She responded well to high-dose glucocorticoids. Four-month follow-up revealed full recovery and absence of recurrence. Since the HPV vaccine is administered worldwide, this case should raise clinicians' awareness regarding the possible CNS complications related to vaccinations, such as anti-GAD65 antibody-associated AE.

Keywords: anti-glutamic acid decarboxylase 65 (anti-GAD65) antibody; autoimmune encephalitis (AE); cervical cancer; human papillomavirus; seizure; vaccination.

Figure 1

MRI (3.0T) at the time of presentation. Axial T2 Weighted Image (A), Axial Fluid attenuated inversion recovery (FLAIR) sequence (B) and coronal FLAIR (C) show cortical thickening and hyper intense signal in the medial aspect of bilateral temporal lobes Right > Left.

Figure 2

Results of cerebrospinal fluid using tissue-based assays (TBA). Hippocampus (A), striatum (B), cerebral cortex (C), and cerebellum (D).