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{
    "pk": 48533,
    "title": "Case Report: Pediatric Hallucinations and Anti-Neuronal Intermediate Filament Autoimmune Encephalitis",
    "subtitle": null,
    "abstract": "<p><strong>Introduction</strong>: Patients with psychiatric concerns often present to an emergency department (ED) for medical evaluation prior to inpatient psychiatry placement. One diagnosis to consider prior to disposition is autoimmune encephalitis (AIE). This report describes a pediatric patient who presented with psychiatric symptoms that required inpatient admission and workup to diagnose a rare form of AIE.</p>\n<p><strong>Case Report: </strong>A 16-year-old female with no known past medical history presented as a transfer from an outside hospital for medical evaluation of two days of auditory and visual hallucinations. Initial labs and imaging were unremarkable. Due to the acuity of her symptoms and abnormal vital signs, she was admitted to the hospital for further medical workup. After almost three weeks inpatient and multiple specialist consultations, she was diagnosed with anti-heavy chain neuronal intermediate filament AIE. The next month of admission included treatment with immunomodulators, antibiotics for associated infections, and malignancy evaluation. Symptoms resolved, and the patient was discharged. The patient remained asymptomatic on immunotherapies, and without psychiatric medications, the following year.</p>\n<p><strong>Conclusion</strong>: During evaluation of psychiatric concerns in the ED, it is essential to consider organic causes of behavioral changes, which can be difficult to discern. Autoimmune encephalitis can be subtle. Features such as autonomic dysregulation, acute or subacute symptom onset, recent infection, autoimmune or malignancy history, cognitive deficits, or focal neurologic findings should raise clinical suspicion. For patients with psychiatric symptoms, the role of an emergency physician is not to diagnose autoimmune encephalitis, but to recognize nuances in patient presentations to best direct proper workup, treatment, and disposition.</p>",
    "language": "eng",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "Autoimmune encephalitis"
        },
        {
            "word": "pediatric"
        },
        {
            "word": "neuronal intermediate filament"
        },
        {
            "word": "case report"
        }
    ],
    "section": "Case Reports",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/5nc3w288",
    "frozenauthors": [
        {
            "first_name": "Amanda",
            "middle_name": "",
            "last_name": "Bjornstad",
            "name_suffix": "",
            "institution": "Loma Linda University Medical Center, Department of Emergency Medicine, Loma Linda, California",
            "department": ""
        },
        {
            "first_name": "Natalie",
            "middle_name": "",
            "last_name": "Oberhauser-Lim",
            "name_suffix": "",
            "institution": "Loma Linda University Medical Center, Department of Emergency Medicine, Loma Linda, California",
            "department": ""
        },
        {
            "first_name": "Tammy",
            "middle_name": "",
            "last_name": "Phan",
            "name_suffix": "",
            "institution": "Loma Linda University Medical Center, Department of Emergency Medicine, Loma Linda, California",
            "department": ""
        },
        {
            "first_name": "Emmelyn",
            "middle_name": "",
            "last_name": "Samones",
            "name_suffix": "",
            "institution": "Loma Linda University Medical Center, Department of Emergency Medicine, Loma Linda, California",
            "department": ""
        },
        {
            "first_name": "Tim",
            "middle_name": "",
            "last_name": "Young",
            "name_suffix": "",
            "institution": "Loma Linda University Medical Center, Department of Emergency Medicine, Loma Linda, California",
            "department": ""
        }
    ],
    "date_submitted": "2025-06-11T15:22:45.538000Z",
    "date_accepted": "2025-09-10T20:31:18.873000Z",
    "date_published": "2026-01-02T00:30:00Z",
    "render_galley": null,
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            "label": "PDF",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/uciem_cpcem/article/48533/galley/48090/download/"
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    ]
}