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Pediatric Rehabilitation

Para-infectious Autoimmune Encephalitis (AE) Following New Onset Type 1 Diabetes Mellitus (T1DM) in Pediatric Patient: Case Report.

Friday, October 24, 2025
8:00 AM - 9:15 AM MT
Location: Case Report Theater

    Poster Presenter(s)

  • Elizabeth Raoof, MD, MEd

    Resident Physician, PGY4
    Medstar Health/Georgetown-National Rehabilitation Hospital PM&R Program
    North Potomac, Maryland

    • Co-Author(s)

  • MF

    Melissa Fleming, MD

    Physician
    Childrens National Medical Center
    Washington, District of Columbia

Disclosure(s):
Elizabeth Raoof, MD, MEd: No financial relationships to disclose
Case Diagnosis: Para-infectious Autoimmune Encephalitis Following New Onset Type 1 Diabetes Mellitus (T1DM) in Pediatric Patient.

Case Description or Program Description: 13-year-old female with no known diabetes history admitted to intensive care in diabetic ketoacidosis following influenza A illness. Hospital course complicated by intubation, prolonged acidemia, kidney and liver dysfunction, and skin breakdown. Labs notable for HgbA1c 11.4%, elevated GAD-65 antibodies, and elevated IA2 antibodies. Patient had continued altered mental status. Cerebrospinal fluid testing negative except elevated protein. Electroencephalogram negative for seizures. Brain MRI showed extensive edema of subcortical and deep cerebral white matter, concerning for para-infectious seronegative AE. She received plasma exchange, intravenous immunoglobins, and steroids. Later noted to have lower extremity weakness and neuropathic pain. Electrodiagnostic exam notable for a length-dependent acute axonal sensorimotor neuropathy, consistent with critical illness neuropathy (CIN). On hospital day 46 she was discharged to acute inpatient rehabilitation. On discharge, patient was independent with ambulation with axillary crutches and a right ankle foot orthosis (AFO). One year later, patient is now able to ambulate independently with just a right AFO.

Setting: Tertiary care pediatric hospital

Assessment/Results: Anti-GAD-65 antibodies are commonly associated with T1DM and are also associated with autoimmune encephalitis, though reports of this in pediatric patients are rare and are usually associated with predominant seizures. This case is among one of the few reported cases of simultaneous presentation of new-onset T1DM and autoimmune encephalitis.

Discussion (relevance): AE and prolonged hospitalization in pediatric patients often requires intensive rehabilitation interventions. This patient required intensive inpatient rehabilitation, management of CIN pain, and neuropsychiatric care.

Conclusions: Pediatric physiatrists are a crucial part of care for patients with AE of all etiologies given their prolonged recovery trajectory. Understanding the clinical course for both common and rare causes of AE is helpful for physiatrists, as they often play a crucial role in family discussions and recovery education.