[Anti-NMDA receptor encephalitis during pregnancy]

Area of Science:

• Neuroimmunology
• Obstetrics
• Neurology

Background:

• Autoimmune encephalitis during pregnancy presents diagnostic challenges, often mimicking psychiatric disorders.
• Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is a severe autoimmune neurological disorder.
• Pregnancy can trigger or exacerbate autoimmune conditions due to complex immunological interactions.

Observation:

• A 19-year-old pregnant female presented with rapid behavioral changes, altered consciousness, and neurological deficits.
• Initial diagnosis was schizophrenia, later revised to suspected encephalitis due to EEG findings and clinical signs like hyperhidrosis and oral dyskinesia.
• Cerebrospinal fluid analysis was negative for HSV, and brain imaging revealed no abnormalities, complicating the diagnosis.

Findings:

• The patient was diagnosed with anti-NMDA receptor (anti-NMDAR) encephalitis confirmed by the presence of anti-NMDAR antibodies in CSF.
• Treatment with methylprednisolone and phenobarbital was initiated, with antibody titers decreasing during treatment and post-delivery.
• The patient experienced a normal delivery at 37 weeks, with both mother and baby remaining healthy without sequelae.

Implications:

• This case highlights the importance of considering autoimmune encephalitis in pregnant patients with unexplained neurological and psychiatric symptoms.
• The findings suggest that pregnancy may trigger anti-NMDAR encephalitis through immunological modulation by the embryo or placenta.
• Early diagnosis and treatment of anti-NMDAR encephalitis in pregnancy are crucial for favorable maternal and fetal outcomes.