Zhu ZY, Jiang ZR, Chang XC, Xu MY, Zhang X, Zhang B, Wang X. Anti-GAD65 antibody-associated autoimmune encephalitis followed by Clostridium difficile colitis: A case report. World J Transl Med 2026; 12(2): 119153 [DOI: 10.5528/wjtm.119153]
Corresponding Author of This Article
Xiao Wang, Department of Radiology, Hennepin Healthcare, 300 S 6th St, Government Center-a 120, Minneapolis, MN 55430, United States. xiao.wang@hcmed.org
Research Domain of This Article
Neurosciences
Article-Type of This Article
case-report
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Zhu ZY, Jiang ZR, Chang XC, Xu MY, Zhang X, Zhang B, Wang X. Anti-GAD65 antibody-associated autoimmune encephalitis followed by Clostridium difficile colitis: A case report. World J Transl Med 2026; 12(2): 119153 [DOI: 10.5528/wjtm.119153]
Zheng-Yang Zhu, Zhuo-Ru Jiang, Meng-Ying Xu, Xin Zhang, Bing Zhang, Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, Jiangsu Province, China
Xue-Chun Chang, Department of Integrative Biology and Physiology, University of Minnesota Medical School, Minneapolis, MN 55455, United States
Xiao Wang, Department of Radiology, Hennepin Healthcare, Minneapolis, MN 55430, United States
Co-first authors: Zheng-Yang Zhu and Zhuo-Ru Jiang.
Author contributions: Zhu ZY contributed to writing-original draft; Jiang ZR, Chang XC, Xu MY, Zhang X, Zhang B contributed to review and editing; Wang X contributed to review and editing, project administration; Zhu ZY and Jiang ZR have made crucial and indispensable contributions towards the completion of the project and thus qualified as the co-first authors of the paper; all authors read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All Authors declare no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Xiao Wang, Department of Radiology, Hennepin Healthcare, 300 S 6th St, Government Center-a 120, Minneapolis, MN 55430, United States. xiao.wang@hcmed.org
Received: January 20, 2026 Revised: February 10, 2026 Accepted: March 3, 2026 Published online: July 28, 2026 Processing time: 190 Days and 13.6 Hours
Abstract
BACKGROUND
Anti-GAD65 antibody-associated autoimmune encephalitis is a rare immune-mediated disorder often presenting with refractory seizures. Diagnosis is established by antibody detection after exclusion of alternative causes. Immunosuppressive therapy is the main treatment but may increase susceptibility to opportunistic infections.
CASE SUMMARY
We present the first reported case of anti-GAD65 antibody-associated autoimmune encephalitis complicated by Clostridium difficile (C. difficile) colitis in a previously healthy 21-year-old woman. The patient initially presented with fever, seizures, and encephalopathy. Extensive workup for infectious and paraneoplastic encephalitis was negative. Elevated anti-GAD65 antibodies in both serum and cerebrospinal fluid are consistent with the suspected diagnosis. She received immunotherapy with intravenous methylprednisolone, immunoglobulin, and plasma exchange. During hospitalization, the patient developed C. difficile colitis, confirmed by sigmoidoscopy, and was treated with oral vancomycin. The onset of colitis coincided with immunosuppressive therapy, highlighting the vulnerability to opportunistic infections. Neurological recovery was gradual but incomplete at one-year follow-up.
CONCLUSION
Clinicians should maintain suspicion for gastrointestinal infections such as C. difficile in patients receiving immunosuppression for autoimmune encephalitis.
Core Tip: We report the first case of anti-GAD65 autoimmune encephalitis in a 21-year-old woman, complicated by Clostridium difficile colitis during immunosuppressive therapy. Neurological recovery was incomplete at 1 year. Clinicians should watch for such infections to improve outcomes.
