Anti-N-methyl-D-aspartate receptor encephalitis, a diagnosis not to miss
  • Tiago Valente
    Internal Medicine Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
  • Gisela Gonçalves
    Internal Medicine Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
  • Valter Duarte
    Internal Medicine Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
  • Gorete Jesus
    Internal Medicine Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal

Keywords

Anti-NMDAR encephalitis, neuropsychiatric symptoms, immunotherapy

Abstract

Anti-N-methyl-D-aspartate receptor (Anti-NMDAR) encephalitis is a rare autoimmune disease, characterized by the presence of neuropsychiatric symptoms. It is sometimes mistaken for a psychiatric disorder and other times not considered in the differential diagnosis of an encephalitic process. Correct identification of this disease and prompt treatment are key for optimal recovery, which might take weeks to months. Many patients manifest severe symptoms, with depressed level of consciousness, breathing dysfunction and dysautonomia requiring admission to the Intensive Care Unit (ICU). We report the case a young male patient with anti-NMDA encephalitis who presented typical neuropsychiatric symptoms. Despite being diagnosed and treated in a timely manner, he did not respond well to first-line immunotherapy and was admitted to the ICU with neurological, respiratory, and cardiovascular dysfunction. This resulted in prolonged hospital admission and many infectious complications. Despite the severity of the disease, the patient managed to recover in the months following discharge from hospital.

VIEW THE ENTIRE ARTICLE

References

  • Dalmau J, Armangue T, Planaguma J, Radosevic M, Mannara F, Leypoldt F, et al. An update on anti-NMDA receptor encephalitis for neurologists and psychiatrists: mechanisms and models. Lancet Neurol 2019;18:1045-1057.
  • Uy CE, Binks S, Irani SR. Autoimmune encephalitis: clinical spectrum and management. Pract Neurol 2021;21:412-423.
  • Dalmau J, Graus F. Antibody-Mediated Encephalitis. N Engl J Med 2018;378:840-851.
  • Titulaer MJ, McCracken L, Gabilondo I, Armangue T, Glaser C, Iizuka T, et al. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study. Lancet Neurol 2013;12:157-165.
  • Gable MS, Sheriff H, Dalmau J, Tilley DH, Glaser CA. The frequency of autoimmune N-methyl-D-aspartate receptor encephalitis surpasses that of individual viral etiologies in young individuals enrolled in the California Encephalitis Project. Clin Infect Dis 2012;54:899-904.
  • Graus F, Titulaer MJ, Balu R, Benseler S, Bien CG, Cellucci T, et al. A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol 2016;15:391-404.
  • Flanagan EP, Geschwind MD, Lopez-Chiriboga AS, Blackburn KM, Turaga S, Binks S, et al. Autoimmune Encephalitis Misdiagnosis in Adults. JAMA Neurol 2023;80:30-39.
  • Views: 456
    HTML downloads: 126
    PDF downloads: 353


    Published: 2023-07-06
    Issue: 2023: Vol 10 No 8 (view)


    How to cite:
    1.
    Valente T, Brites Gonçalves G, Duarte V, Jesus G. Anti-N-methyl-D-aspartate receptor encephalitis, a diagnosis not to miss. EJCRIM 2023;10 doi:10.12890/2023_003974.