{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T15:07:01Z","timestamp":1784819221939,"version":"3.55.0"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Chronic mercury exposure may be a potential risk factor for anti-LGI1\/Caspr2 autoimmune encephalitis (AE). The effect of chelation therapy on coexisting AE is unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We report three patients from West China Fourth Hospital, Sichuan University (September\u2013November 2025) with confirmed chronic mercury exposure, anti-LGI1\/Caspr2 antibody positivity, and DMPS chelation. Clinical course, antibody titers, and treatment response were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Within 1-3 days of chelation initiation, all three patients developed acute neuropsychiatric deterioration, a phenomenon not previously documented. Each\u00a0patient fully recovered with prompt immunotherapy, with favorable long-term\u00a0outcomes (mRS 0\u20132). This observation appears to contrast with experimental\u00a0animal models where chelators attenuate rather than exacerbate autoimmune neuroinflammation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This series suggests that chelation therapy may be temporally associated with acute worsening in this specific population, highlighting a potential therapeutic dilemma: the standard treatment for mercury may, in some cases, be associated with exacerbation of the autoimmune process that may be related to its use. Screening for occult heavy metal exposure may be considered in unexplained AE, and immunotherapy should be initiated promptly if deterioration occurs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1855642","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T05:35:19Z","timestamp":1784612119000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Mercury exposure and anti-LGI1\/Caspr2 autoimmune encephalitis: a case series and literature review on the paradoxical worsening after chelation therapy"],"prefix":"10.3389","volume":"17","author":[{"given":"Chao","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Neurology, West China Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"Department of Geriatric Medicine and Neurology, West China School of Public Health \/ West China Fourth Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurology, West China Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"Department of Geriatric Medicine and Neurology, West China School of Public Health \/ West China Fourth Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ge","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Neurology, West China Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"Department of Psychiatry, West China Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junming","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Radiology, West China School of Public Health and West China Fourth Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Neurology, West China Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1007\/s10072-020-04831-6","article-title":"Immune-associated neuromyotonia syndrome following mercury poisoning","volume":"42","author":"Li","year":"2021","journal-title":"Neurol Sci"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1177\/0009922820915885","article-title":"Autoimmune manifestations of acute mercury toxicity","volume":"59","author":"Lu","year":"2020","journal-title":"Clin Pediatr (Phila)"},{"key":"B3","doi-asserted-by":"publisher","first-page":"577197","DOI":"10.1016\/j.jneuroim.2020.577197","article-title":"Mercury-induced 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