{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T14:24:11Z","timestamp":1774880651729,"version":"3.50.1"},"reference-count":22,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,8,7]]},"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:p>Autoimmune encephalitis is a rare spectrum of disease that can be a complication of chronic immunosuppression. Diagnosis often requires the presence of antineuronal antibodies, but many causative antibodies have not yet been identified. Antibody-negative autoimmune encephalitis (AbNAE) is especially difficult to diagnose and must rely largely on exclusion of other causes. In chronically immune-suppressed transplant recipients, the differential is broad, likely resulting in underdiagnosis and worse outcomes. Here, we present a 58-year-old liver transplant recipient taking tacrolimus for prevention of chronic rejection who presented with 5\u2009days of confusion, lethargy and lightheadedness. He was diagnosed with AbNAE after an extensive workup and recovered fully after high-dose corticosteroids. Our case highlights the importance of recognising the association between chronic immunosuppression and autoimmune encephalitis. Autoimmune encephalitis, even in the absence of characterised antibodies, should be considered when transplant recipients present with central neurologic symptoms.<\/jats:p>","DOI":"10.1136\/bcr-2020-235777","type":"journal-article","created":{"date-parts":[[2020,9,15]],"date-time":"2020-09-15T17:27:33Z","timestamp":1600190853000},"page":"e235777","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Antibody-negative autoimmune encephalitis as a complication of long-term immune-suppression for liver transplantation"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5143-1431","authenticated-orcid":false,"given":"Jeffrey","family":"Spindel","sequence":"first","affiliation":[{"name":"Internal Medicine, University of Louisville, Louisville, Kentucky, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Heckroth","sequence":"additional","affiliation":[{"name":"Internal Medicine, University of Louisville, Louisville, Kentucky, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis","family":"Marsano","sequence":"additional","affiliation":[{"name":"Gastroenterology, Hepatology, and Nutrition, University of Louisville, Louisville, Kentucky, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,9,15]]},"reference":[{"key":"2025082622392292000_13.9.e235777.1","doi-asserted-by":"publisher","DOI":"10.1172\/JCI119609"},{"key":"2025082622392292000_13.9.e235777.2","doi-asserted-by":"crossref","unstructured":"Renjen PN , Khanna L , Rastogi R , et al . 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Novel surrogate markers of CNS inflammation in CSF in the diagnosis of autoimmune encephalitis. 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