Autoimmune encephalitis with dizziness in children: A case report presented to the otolaryngology department

Abstract

Rationale: Motion sickness is frequently encountered condition, characterized primarily by symptoms such as nausea, vomiting, headache, dizziness, and drowsiness. Autoimmune encephalitis refers to a group of diseases that can present with a variety of clinical symptoms according to the expressed autoantigen. One of the rare types is myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). Herein, we report the case of a child who presented to our otolaryngology department with a diagnosis of motion sickness but was eventually diagnosed with MOGAD. To our knowledge, this is the first such case reported in the literature.

Patient concerns: An 11-year-old boy presented to a vertigo clinic with the primary complaints of dizziness, occasional nausea, and vomiting after traveling with his family for 3 days. He was diagnosed with motion sickness and was administered oral betastine mesylate tablets (6 mg, 3 times/d for 3 days). The dizziness resolved after 3 days of medication. However, 1 week later, the child developed symptoms of vision loss, poor mental performance, and sluggish responses.

Diagnosis: The patient was diagnosed with MOGAD.

Interventions: The patient was treated with human immunoglobulin (2 g/kg, divided into 3 doses), mannitol, and a high dose of methylprednisolone succinate (20 mg/kg for 3 consecutive days). The dose of methylprednisolone succinate was then gradually tapered over 18 days.

Outcomes: After 15 days of treatment, the child's vision in the left eye improved, with visual acuity returned to 0.25. His sense of taste and pain in the left limb returned to normal, his mental responses were good, and no antinuclear antibodies were detectable.

Lessons: Although most childhood episodes of dizziness are benign, it is important for clinicians to remain vigilant for the possibility of central nervous system disease as the underlying cause. When the diagnosis is uncertain, doctors and parents must closely monitor affected children to avoid misdiagnosis and treatment delays.

Figure 1.

Bithermal caloric test at August 23, 2022. After the right ear was injected with cold air and hot air, the sum of slow phase velocity was 10°/s, while that of the left ear was 5°/s, and the canal paralysis value is 33%, which was >25%, indicating that the low-frequency response of the left horizontal semicircular canal was reduced.

Figure 2.

Cerebral MRI in FLAIR image at admission. (A) showed hyperintense lesion in the temporal regions (arrowheads). (B) showed hyperintense lesion in the bilateral insular regions (arrowheads). FLAIR = fluid attenuated inversion recovery, MRI = magnetic resonance imaging.

Figure 3.

Cerebral MRI in FLAIR image at discharge and 1 yr after discharge. (A and B) showed that hyperintense lesion in the bilateral insular and temporal lobe lesions had no significant changes compared with Fig. 2 (arrowheads). (C and D) showed normal brain tissue 1 yr after discharge. FLAIR = fluid attenuated inversion recovery, MRI = magnetic resonance imaging.