Abstract
Limbic encephalitis is an autoimmune inflammatory pathology that affects the limbic system, which can occur in people of all ages, but occurs more frequently in adults over 45 years of age with neuropsychiatric symptoms. It is frequently associated with antibodies, with triggering factors such as tumors, viral infections or immune checkpoint inhibitors. Timely recognition of autoimmune encephalitis allows patients to be offered immunosuppressive treatment as soon as possible to avoid the appearance of serious complications and improve their functional prognosis. In this sense, the case of an adult patient who began with neuropsychiatric symptoms four years prior to the diagnosis with negative antibodies is presented. The diagnosis was ruled out due to the poor response to psychiatric treatment and the images observed in the magnetic resonance imaging; it was evaluated in a legal medical instance after treatment with the monoclonal antibody Rituximab. Although it is described that the diagnosis is made by magnetic resonance studies, electroencephalography, cerebrospinal fluid analysis and anti-neuronal autoantibody tests, in the reported patient only a brain MRI with bifrontal hyperintensity areas with cortical borders was documented, neither autoantibodies nor an underlying tumor could be detected, but he presented a good clinical response with Rituximab, currently he only presents few neurological deficits. Therefore, it is important to consider this pathology as a differential diagnosis in a patient with psychiatric symptoms, to avoid neurological sequelae.

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