{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T20:09:22Z","timestamp":1790453362265,"version":"4.1.0"},"reference-count":17,"publisher":"Springer Science and Business Media LLC","issue":"10","license":[{"start":{"date-parts":[[2024,8,31]],"date-time":"2024-08-31T00:00:00Z","timestamp":1725062400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,8,31]],"date-time":"2024-08-31T00:00:00Z","timestamp":1725062400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002839","name":"Charit\u00e9 - Universit\u00e4tsmedizin Berlin","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002839","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Neurol"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>There are established associations between viral and autoimmune encephalitis as well as between autoimmune encephalitis and demyelinating central nervous system (CNS) diseases. Here, we report the evolution from varicella zoster virus (VZV) encephalitis to limbic autoimmune encephalitis (AIE) to multiple sclerosis (MS) in one patient.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case report<\/jats:title>\n                <jats:p>A woman in her mid-thirties presented with headache, aphasia, and a generalized tonic\u2013clonic seizure. Cerebrospinal fluid (CSF) VZV polymerase chain reaction was positive and treatment with acyclovir was administered for VZV encephalitis. Five months later, the patient presented with cognitive deficits and MRI showed new bilateral hippocampal T2-hyperintensities. CSF analyses revealed pleocytosis and neuropil antibodies in tissue-staining. A diagnosis of limbic AIE was established and treatment with IV steroids and IV immunoglobulins initiated. One year later, the patient developed paresthesia of both legs and magnetic resonance imaging studies now showed new supratentorial and spinal demyelinating lesions. The patient was diagnosed with MS and treatment was changed to rituximab.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>This unique case report links three important neuroimmunological entities in characterizing the evolution from infectious to autoimmune encephalitis to multiple sclerosis in one patient. Identification of such rare clinical constellations is critical for correct treatment choice and provides important novel insights into the pathophysiology of neuroimmunological disorders including viral triggers and overlap manifestations of autoimmune CNS diseases.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00415-024-12659-9","type":"journal-article","created":{"date-parts":[[2024,8,31]],"date-time":"2024-08-31T17:02:18Z","timestamp":1725123738000},"page":"7035-7038","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Evolution from viral encephalitis to autoimmune encephalitis to multiple sclerosis: a case report"],"prefix":"10.1007","volume":"271","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0952-5658","authenticated-orcid":false,"given":"Katharina","family":"Wurdack","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8283-7976","authenticated-orcid":false,"given":"Harald","family":"Pr\u00fcss","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7665-1171","authenticated-orcid":false,"given":"Carsten","family":"Finke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,8,31]]},"reference":[{"issue":"6","key":"12659_CR1","doi-asserted-by":"publisher","first-page":"902","DOI":"10.1002\/ana.23689","volume":"72","author":"H Pr\u00fcss","year":"2012","unstructured":"Pr\u00fcss H et al (2012) N-methyl-D-aspartate receptor antibodies in herpes simplex encephalitis. Ann Neurol 72(6):902\u2013911","journal-title":"Ann Neurol"},{"issue":"10","key":"12659_CR2","doi-asserted-by":"publisher","first-page":"4306","DOI":"10.1093\/brain\/awad238","volume":"146","author":"T Armangue","year":"2023","unstructured":"Armangue T et al (2023) Neurologic complications in herpes simplex encephalitis: clinical, immunological and genetic studies. Brain 146(10):4306\u201319","journal-title":"Brain"},{"issue":"24","key":"12659_CR3","doi-asserted-by":"publisher","first-page":"2309","DOI":"10.1212\/WNL.0000000000001072","volume":"83","author":"WR Sch\u00e4bitz","year":"2014","unstructured":"Sch\u00e4bitz WR et al (2014) VZV brainstem encephalitis triggers NMDA receptor immunoreaction. Neurology 83(24):2309\u20132311","journal-title":"Neurology"},{"issue":"2","key":"12659_CR4","doi-asserted-by":"publisher","DOI":"10.1212\/NXI.0000000000000537","volume":"6","author":"PA Prakash","year":"2019","unstructured":"Prakash PA et al (2019) Anti-NMDAR encephalitis with concomitant varicella zoster virus detection and nonteratomatous malignancy. Neurol Neuroimmunol Neuroinflamm 6(2):e537","journal-title":"Neurol Neuroimmunol Neuroinflamm"},{"issue":"3","key":"12659_CR5","doi-asserted-by":"publisher","first-page":"456","DOI":"10.1007\/s13365-022-01080-5","volume":"28","author":"N Fatma","year":"2022","unstructured":"Fatma N et al (2022) Atypical anti-NMDA receptor encephalitis associated with varicella zoster virus infection. J Neurovirol 28(3):456\u2013459","journal-title":"J Neurovirol"},{"issue":"3","key":"12659_CR6","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1002\/ana.24117","volume":"75","author":"MJ Titulaer","year":"2014","unstructured":"Titulaer MJ et al (2014) Overlapping demyelinating syndromes and anti\u2013N-methyl-D-aspartate receptor encephalitis. Ann Neurol 75(3):411\u2013428","journal-title":"Ann Neurol"},{"key":"12659_CR7","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.857443","volume":"13","author":"S Zhang","year":"2022","unstructured":"Zhang S et al (2022) Clinical characteristics of anti-N-methyl-d-aspartate receptor encephalitis overlapping with demyelinating diseases: a review. Front Immunol 13:857443","journal-title":"Front Immunol"},{"issue":"4","key":"12659_CR8","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1016\/S1474-4422(15)00401-9","volume":"15","author":"F Graus","year":"2016","unstructured":"Graus F et al (2016) A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol 15(4):391\u2013404","journal-title":"Lancet Neurol"},{"issue":"2","key":"12659_CR9","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1016\/S1474-4422(17)30470-2","volume":"17","author":"AJ Thompson","year":"2018","unstructured":"Thompson AJ et al (2018) Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol 17(2):162\u2013173","journal-title":"Lancet Neurol"},{"issue":"8","key":"12659_CR10","doi-asserted-by":"publisher","first-page":"1663","DOI":"10.3390\/v15081663","volume":"15","author":"PGE Kennedy","year":"2023","unstructured":"Kennedy PGE (2023) The spectrum of neurological manifestations of varicella-zoster virus reactivation. Viruses 15(8):1663","journal-title":"Viruses"},{"issue":"12","key":"12659_CR11","doi-asserted-by":"publisher","first-page":"798","DOI":"10.1038\/s41577-021-00543-w","volume":"21","author":"H Pr\u00fcss","year":"2021","unstructured":"Pr\u00fcss H (2021) Autoantibodies in neurological disease. Nat Rev Immunol 21(12):798\u2013813","journal-title":"Nat Rev Immunol"},{"issue":"4","key":"12659_CR12","doi-asserted-by":"publisher","first-page":"1130","DOI":"10.1093\/brain\/awad419","volume":"147","author":"J Cleaver","year":"2024","unstructured":"Cleaver J et al (2024) The immunobiology of herpes simplex virus encephalitis and post-viral autoimmunity. Brain 147(4):1130\u20131148","journal-title":"Brain"},{"issue":"14","key":"12659_CR13","doi-asserted-by":"publisher","first-page":"1816","DOI":"10.1177\/1352458520970841","volume":"26","author":"C Walton","year":"2020","unstructured":"Walton C et al (2020) Rising prevalence of multiple sclerosis worldwide: Insights from the Atlas of MS, third edition. Mult Scler 26(14):1816\u20131821","journal-title":"Mult Scler"},{"issue":"6578","key":"12659_CR14","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1126\/science.abj8222","volume":"375","author":"K Bjornevik","year":"2022","unstructured":"Bjornevik K et al (2022) Longitudinal analysis reveals high prevalence of Epstein-Barr virus associated with multiple sclerosis. Science 375(6578):296\u2013301","journal-title":"Science"},{"issue":"7900","key":"12659_CR15","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1038\/s41586-022-04432-7","volume":"603","author":"TV Lanz","year":"2022","unstructured":"Lanz TV et al (2022) Clonally expanded B cells in multiple sclerosis bind EBV EBNA1 and GlialCAM. Nature 603(7900):321\u2013327","journal-title":"Nature"},{"key":"12659_CR16","doi-asserted-by":"publisher","first-page":"64","DOI":"10.12659\/AJCR.901391","volume":"18","author":"Z Karaaslan","year":"2017","unstructured":"Karaaslan Z et al (2017) A case of seronegative limbic encephalitis with multiple sclerosis: a possible overlapping syndrome. Am J Case Rep 18:64\u201366","journal-title":"Am J Case Rep"},{"issue":"2","key":"12659_CR17","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1056\/NEJMra1401483","volume":"378","author":"DS Reich","year":"2018","unstructured":"Reich DS, Lucchinetti CF, Calabresi PA (2018) Multiple sclerosis. N Engl J Med 378(2):169\u2013180","journal-title":"N Engl J Med"}],"container-title":["Journal of Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00415-024-12659-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00415-024-12659-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00415-024-12659-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,3]],"date-time":"2024-10-03T03:54:39Z","timestamp":1727927679000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00415-024-12659-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,31]]},"references-count":17,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2024,10]]}},"alternative-id":["12659"],"URL":"https:\/\/doi.org\/10.1007\/s00415-024-12659-9","relation":{},"ISSN":["0340-5354","1432-1459"],"issn-type":[{"value":"0340-5354","type":"print"},{"value":"1432-1459","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,31]]},"assertion":[{"value":"3 June 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 August 2024","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 August 2024","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 August 2024","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"On behalf of all authors, the corresponding author states that there is no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}}]}}