Autoimmune glial fibrillary acidic protein astrocytopathy: a case report from Hong Kong

Abstract

Autoimmune glial fibrillary acidic protein astrocytopathy (GFAP-A) is a rare autoimmune disorder first described in 2016. 1 It typically presents as acute or subacute meningitis, encephalitis, and/ or myelitis, with symptoms such as fever, cognitive decline, limb weakness, and autonomic dysfunction.To date, over 600 cases have been reported globally, predominantly in the United States, Europe, and Chinese Mainland.2 Few cases have been documented in Hong Kong. Case presentationA 63-year-old male smoker with a history of hypertension was first admitted to Princess Margaret Hospital in June 2024 for recurrent dizziness, headaches, hypertension, low-grade fever (37.9°C), and dry cough.Initial evaluation revealed unremarkable brain computed tomography and magnetic resonance imaging (MRI), and mild hyponatraemia (133 mmol/L).Symptoms temporarily improved with amoxicillin and clavulanic acid and an antihypertensive agent.