Case Report: Mercury exposure and anti-LGI1/Caspr2 autoimmune encephalitis: a case series and literature review on the paradoxical worsening after chelation therapy.

This series suggests that chelation therapy may be temporally associated with acute worsening in this specific population, highlighting a potential therapeutic dilemma: the standard treatment for mercury may, in some cases, be associated with exacerbation of the autoimmune process that may be related to its use.

Screening for occult heavy metal exposure may be considered in unexplained autoimmune encephalitis, and immunotherapy should be initiated promptly if deterioration occurs.