Autoimmune glial fibrillary acidic protein astrocytopathy with diverse clinical manifestations:a case report

WANG Shengxiang; CUI Mingxu; LIU Hongdong; HAN Guosheng

doi:10.3969/j.issn.1671-2897.2026.02.019

Abstract：Objective To enhance the clinical recognition and differential diagnostic capabilities for autoimmune glial fibrillary acidic protein(GFAP)astrocytopathy,a recently identified autoimmune disorder of the central nervous system.Methods The case of a 67-year-old male patient admitted to the First Department of Neurology at the Affiliated Hospital of Shandong Second Medical University with a chief complaint of"neck pain and recurrent fever lasting more than 50 days"was reported.The patient initially was presented with marked daytime somnolence,fever,and urinary difficulty.Initial cerebrospinal fluid(CSF)analyses conducted both prior to admission and upon hospitalization revealed decreased glucose and chloride concentrations along with elevated protein levels.No anti-GFAP antibody testing was performed initially,and the patient showed no response to antimicrobial or antiviral therapies.Subsequently,CSF analysis detected positive anti-GFAP antibodies at a titer of 1:1 000.Results Following the diagnosis of autoimmune GFAP astrocytopathy,the patient received methylprednisolone pulse therapy,resulting in significant improvement in clinical symptoms.Conclusions This case highlights that in patients presented with nonspecific manifestations such as excessive somnolence,urinary dysfunction,and fever,particularly after exclusion of common infectious etiologies and lack of response to antimicrobial or antiviral treatments,autoimmune GFAP astrocytopathy should be considered in the differential diagnosis.Early detection of anti-GFAP antibodies in the CSF is critical for timely and accurate diagnosis,and prompt initiation of immunotherapy,such as corticosteroid treatment,can lead to favorable clinical outcomes.