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Anti-N-methyl-D-aspartate receptor encephalitis that aggravates after acinetobacter baumannii pneumonia: A case
Cheng C Wang1, Da J Li1, Yi Q Xia2
1Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
Abstract:
We report an atypical case of anti-N-methyl-D-aspartate receptor encephalitis (ANMDARE). A 27-year-old man diagnosed with ANMDARE received immunotherapy and had a good recovery. However, within one month, he developed severe status epilepticus and decreased level of conscience with new hyperpyrexia and dyspnea, and was admitted to the emergency intensive care unit. Acinetobacter baumanii were found in the sputum culture; and anti-NMDAR antibodies were positive (titer: 1/80) in the cerebrospinal fluid. Repeated immunotherapy was administered with antibacterial agents, and the patient recovered except for mild psychiatric sequelae. This is the first report of ANMDARE that aggravates after acinetobacter baumannii pneumonia. Awareness and knowledge of this disorder should be extended, especially in the emergency medicine community.
Insights
Anti-N-methyl-D-aspartate receptor encephalitis (ANMDARE) can relapse with severe complications. This case highlights a rare ANMDARE exacerbation following Acinetobacter baumannii pneumonia, emphasizing the need for emergency physician awareness.
Area of Science:
- Neurology
- Infectious Disease
Background:
- Anti-N-methyl-D-aspartate receptor encephalitis (ANMDARE) is an autoimmune disorder typically presenting with psychiatric, neurologic, and autonomic symptoms.
- Early diagnosis and immunotherapy are crucial for favorable outcomes in ANMDARE.
Observation:
- A 27-year-old male with ANMDARE initially responded well to immunotherapy.
- He later experienced severe status epilepticus, decreased consciousness, hyperpyrexia, and dyspnea, necessitating intensive care.
- Acinetobacter baumannii pneumonia was identified, with positive anti-NMDAR antibodies in cerebrospinal fluid.
Findings:
- This case represents the first documented instance of ANMDARE exacerbation following Acinetobacter baumannii pneumonia.
- Treatment involved repeated immunotherapy and antibacterial agents.
Implications:
- This case underscores the potential for ANMDARE to relapse with severe infectious complications.
- Increased awareness among emergency medicine professionals is vital for recognizing and managing such complex cases.
- Further research into the interplay between infections and ANMDARE relapses is warranted.