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Obsessive-Compulsive Disorder With Inflammatory Cerebrospinal Fluid Changes and Intrathecal Antinuclear Antibody Staining

  • Dominique Endres
    Correspondence
    Address correspondence to Dominique Endres, M.D.
    Affiliations
    Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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  • Miriam A. Schiele
    Affiliations
    Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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  • Björn C. Frye
    Affiliations
    Department of Pneumology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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  • Andrea Schlump
    Affiliations
    Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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  • Bernd Feige
    Affiliations
    Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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  • Kathrin Nickel
    Affiliations
    Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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  • Benjamin Berger
    Affiliations
    Clinic of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany

    Department of Neurology, Helios Clinic Pforzheim, Pforzheim, Germany
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  • Marco Reisert
    Affiliations
    Department of Diagnostic and Interventional Radiology – Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany

    Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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  • Horst Urbach
    Affiliations
    Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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  • Katharina Domschke
    Affiliations
    Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany

    Center for Basics in Neuromodulation, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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  • Nils Venhoff
    Affiliations
    Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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  • Harald Prüss
    Affiliations
    Department of Neurology and Experimental Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany

    German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany
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  • Ludger Tebartz van Elst
    Affiliations
    Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Published:September 02, 2022DOI:https://doi.org/10.1016/j.biopsych.2022.06.037
      Autoimmune-mediated obsessive-compulsive disorder (OCD) during childhood has long been established in the context of pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (
      • Swedo S.E.
      • Leonard H.L.
      • Mittleman B.B.
      • Allen A.J.
      • Rapoport J.L.
      • Dow S.P.
      • et al.
      Identification of children with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections by a marker associated with rheumatic fever.
      ). In adult psychiatry, the topic has increasingly gained interest in light of new developments regarding autoimmune encephalitis and autoimmune psychosis (
      • Prüss H.
      Autoantibodies in neurological disease.
      ,
      • Pollak T.A.
      • Lennox B.R.
      • Müller S.
      • Benros M.E.
      • Prüss H.
      • Tebartz van Elst L.
      • et al.
      Autoimmune psychosis: An international consensus on an approach to the diagnosis and management of psychosis of suspected autoimmune origin.
      ). Hence, diagnostic criteria for autoimmune OCD in adulthood have been proposed recently, and the first respective cases were reported (
      • Endres D.
      • Pollak T.A.
      • Bechter K.
      • Denzel D.
      • Pitsch K.
      • Nickel K.
      • et al.
      Immunological causes of obsessive-compulsive disorder: Is it time for the concept of an "autoimmune OCD" subtype?.
      ,
      • Endres D.
      • Mertens L.
      • Berger B.
      • Reisert M.
      • Runge K.
      • Nickel K.
      • et al.
      Autoimmune obsessive-compulsive disorder with novel anti-basal ganglia antibodies.
      ). For the detection of neuroinflammatory processes, cerebrospinal fluid (CSF) analysis (besides the far more invasive brain biopsy) is considered the most sensitive diagnostic tool (
      • Pankratz P.
      • von Zedtwitz K.
      • Runge K.
      • Denzel D.
      • Nickel K.
      • Schlump A.
      • et al.
      Cerebrospinal fluid findings in adult patients [published online ahead of print Jul 29].
      ). Here, we present 2 paradigmatic OCD patients with inflammatory CSF signals including antinuclear antibody staining in CSF and magnetic resonance imaging (MRI)/electroencephalography (EEG) findings compatible with OCD.
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