A 16-year-old girl in California walked into an ER hallucinating a “flying green dinosaur” and hearing voices — and it turned out her immune system was attacking her own brain wiring.
Live Science’s Diagnostic Dilemma (Oct. 14) walks through the case report: trembling, sweating, racing pulse, shallow breathing. She’d described hallucinations since seventh grade; her parents said the psychosis spiked only 48 hours before arrival. CT scan: clean. First spinal tap: failed. EEG: no answers. Day two: full catatonia. Lorazepam brought her back. Psych transfer stalled when she couldn’t feed herself.
The breakthrough came later: cerebrospinal fluid tested positive for autoantibodies targeting neuronal intermediate filament (NIF) — structural proteins in nerve cells. Diagnosis: autoimmune encephalitis. No tumor on MRI or PET. Treatment stacked steroids, immunoglobulin, rituximab, and five rounds of plasmapheresis. Nearly two months in hospital, then a year of tapering psych meds while immunotherapy continued.
Autoimmune encephalitis is rare — roughly 5 to 8 per 100,000 in one U.K. study — and pediatric anti-NIF cases are rarer still than the better-known anti-NMDA flavor. The girl’s family noted a cough three weeks earlier after a Philippines trip. The “dinosaur” wasn’t a punchline. It was a medical alarm bell with feathers of green.
Sources: Live Science — https://www.livescience.com/health/immune-system/diagnostic-dilemma-teenagers-rare-autoimmune-disorder-caused-her-to-hallucinate-a-flying-green-dinosaur
Featured image: AI-generated editorial illustration by Bugle Blast.
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