A 47-year-old male presented with subacute onset of cognitive decline, behavioral changes along with staring spells. The patient was initially evaluated at outside facility, subsequently diagnosed with epilepsy, and treated with valproic acid. Three months later, there was change in semiology of the seizures and increase in frequency of seizures despite being on maximum dose. After a prolonged seizure, he was brought to our hospital for an evaluation. During the initial neurological examination, he was alert and nonverbal, and catatonic features were noted in all four limbs. Initial evaluation includes routine blood workup, complete blood count (CBC), comprehensive metabolic panel (CMP), erythrocyte sedimentation rate (ESR), blood culture, urine analysis, meningitis panel, comprehensive drug screen, cryptococcal antigen testing, and cerebrospinal fluid (CSF) analysis which were found to be unremarkable. EEG showed intermittent right temporal slowing suggesting of neuronal dysfunction in the same region. Magnetic resonance imaging (MRI) showed mild right hippocampal atrophy. At the time of imaging, the infectious workup came back negative. The diagnosis of autoimmune encephalitis was suspected, and he was treated with immunoglobulin (IVIG) and methylprednisolone for 5 days that significantly improved his cognition and seizure free at the time of discharge. His paraneoplastic panel later came positive for anti-leucine-rich glioma-inactivated 1 (LGI1) antibody and voltage-gated potassium channel (VGKC) antibody, thus confirming the diagnosis of anti-LGI1 encephalitis. At the 4-month follow-up, he continues to show improvement with cognition and seizures were well controlled with immunotherapy and antiepileptic medications. However, the patient continues to complain of aching and burning pain which predominately involves bilateral upper extremities when compared to lower extremities despite being on medications such as pregabalin, gabapentin, duloxetine, and opioids. The patient underwent magnetic resonance imaging (MRI) at the University of Missouri Health Care System using a 1.5-T Aera MRI scanner and a standard 20-channel phase head/neck trim coil. High-resolution images were obtained via three-dimensional T1-, T2-, and T2 STIR-weighted images with a thickness of 5 mm. The MRI showed bilateral enhancement of dorsal root ganglia from C3–C7 spinal level as shown in Figs. 1a–c and 2a, b. He is currently on a monthly IVIG infusion of 1 g/kg infused over 2 days to prevent disease relapse and continues to have nociceptive pain despite being on immunomodulation therapy along with multiple neuropathic medications and interventional pain procedures. Immunosuppressive therapy was deferred due to a history of hepatitis B. Written informed consent was obtained from the patient for the publication of this case report and accompanying images. Case reports are exempt from institutional review board (IRB) approval in our institute.