A Rare Case of Anti-glutamic Acid Decarboxylase 65 Autoimmune Encephalitis Followed by Acute Graft-Versus-Host Disease in Simultaneous Kidney and Pancreas Transplant

Simultaneous kidney and pancreas transplant is a treatment option for diabetic patients with kidney failure. Posttransplant complications are common and include surgical complications, and infections, as well as immunosuppression toxicity. Some complications like autoimmune encephalitis and graft-versus-host disease have been reported after hematopoietic stem cell transplant but very few reports are published in solid organ transplants. We present a case of a 32-year-old woman who underwent simultaneous kidney and pancreas transplants and presented 2 weeks after transplant with subacute altered mental status as well as persistent fevers. Extensive infectious, rheumatologic, hematologic, and neurologic workups revealed multiple hyperintense brain lesions with the presence of glutamic acid decarboxylase 65 autoantibodies in the serum and cerebrospinal fluid. She initially improved with steroids and immunoglobulin, but symptoms quickly returned. Subsequently, she developed rapid pancytopenia along with transaminitis. The repeat bone marrow biopsy was consistent with aplastic anemia, and the liver biopsy showed subtle biliary ductal changes consistent with graft-versus-host disease. She was evaluated for a bone marrow transplant but because of persistent infections was deemed not to be a candidate. She died 6 months posttransplant.