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Pediatric Rehabilitation

Glial Fibrillary Acidic Protein Autoimmune Encephalitis in the Pediatric Inpatient Rehabilitation Setting: A case report

Friday, October 24, 2025
12:00 PM - 1:30 PM MT
Location: Kiosk 10

    Primary Author(s)

  • MH

    Morgan Howells-Resendez, MD (she/her/hers)

    Resident Physician
    ECU Health (Vidant Medical Center/East Carolina University) PM&R Program
    Greenville, North Carolina

  • JP

    Jacob Pannaman, DO

    Resident
    Campbell University Jerry M Wallace School of Osteopathic Medicine
    Winterville, North Carolina

    • Co-Author(s)

  • RL

    Robert Lombard, MD

    Assistant Clinical Professor
    ECU Health (Vidant Medical Center/East Carolina University) PM&R Program
    Grimesland, North Carolina

    • Poster Presenter(s)

  • ES

    Emma Spilsted, MD

    Resident Physician
    East Carolina University Medical Center
    Greenville, North Carolina

Disclosure(s):
Morgan Howells-Resendez, MD: No financial relationships to disclose
Robert Lombard, MD: No financial relationships to disclose
Emma Spilsted, MD: No financial relationships to disclose
Case Diagnosis: 14 year-old female presented to the emergency department with diarrhea, vomiting, and left hemiparesis, and subsequently developed altered mental status secondary to glial fibrillary acidic protein (GFAP) autoimmune encephalitis.

Case Description or Program Description: Patient initially presented with diarrhea and vomiting and was admitted to the pediatric intensive care unit for vasopressor support in the setting of suspected sepsis. Infectious work-up was negative, however MRI brain showed cytotoxic lesions in the splenium of the corpus callosum. Neurology was consulted and recommended autoimmune workup and intravenous immunoglobulin (IVIG) for 5 days. After the course of IVIG the patient's altered mental status began resolving. Patient continued to have left upper and lower extremity weakness with decreased sensation and abnormal gait. During inpatient rehabilitation stay, she continued to exhibit mild memory loss and confusion that resolved by discharge.

Setting: Inpatient Rehabilitation

Assessment/Results: Autoimmune workup was positive for GFAP antibody in cerebrospinal fluid, and treatment consisted of 5-day course of IVIG. At neurology follow-up patient showed improvement of symptoms without relapse. Repeat MRI 3 months post-admission noted resolution of cytotoxic lesion of corpus callosum.

Discussion (relevance): GFAP is an intermediate filament protein that is expressed primarily in astrocytes in the central nervous system. Development of antibodies to GFAP can lead to autoimmune GFAP astrocytopathy and symptoms can include headache, vision changes, seizures, movement disorders, and encephalopathy. MRI can show linear perivascular hyperintensities. Treatment typically includes IVIG with possible addition of steroids. GFAP encephalitis can also be associated with type 1 diabetes mellitus, thyroid disease, rheumatoid arthritis, and certain cancers. It is most common in female adults, however has been documented rarely in adolescents.

Conclusions: Encephalopathy in pediatric patients can be difficult to diagnose given the wide variation in presentations and etiologies. It is important to also consider autoimmune etiologies in this population, and consider course of IVIG and/or steroids while workup is pending.