First Bahraini adolescent with anti-NMDAR-Ab encephalitis

Area of Science:

• Neuroscience
• Immunology
• Infectious Disease

Background:

• Anti-N-methyl-D-aspartate-receptor (NMDA-R) encephalitis is an emerging autoimmune disorder.
• It is often associated with paraneoplastic syndromes and presents with complex neuropsychiatric symptoms.

Observation:

• The patient experienced headache, behavioral changes, seizures, hallucinations, hypoventilation, and choreoathetosis.
• Initial misdiagnosis as schizophrenia and treatment with antipsychotics preceded further deterioration.
• Mycoplasma IGM positivity and CSF findings of high white cells and anti-NMDA-R antibodies were noted.

Findings:

• Brain MRI revealed acute disseminated encephalomyelitis.
• The patient responded to a multimodal treatment approach including antibiotics, antiepileptics, steroids, and plasmapheresis.
• No underlying malignancy was detected, and full recovery took approximately one year with rehabilitation.

Implications:

• This case highlights the importance of considering anti-NMDA-R encephalitis in patients with unexplained neuropsychiatric symptoms, even without fever.
• The condition is challenging to diagnose and can be easily missed, underscoring the need for increased awareness among clinicians.
• Prompt diagnosis and comprehensive treatment are vital for improving patient outcomes in anti-NMDA-R encephalitis.