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Anti-N-methyl-D-aspartate receptor encephalitis associated with acute Toxoplasma gondii infection: A case report

Xiaotang Cai1, Hui Zhou, Yongmei Xie

  • 1Department of Pediatrics, West China Second University Hospital Key Laboratory of Obstetric and Gynaecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, Sichuan Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.

Medicine
|February 15, 2018
PubMed
Abstract

Insights

Acute acquired toxoplasma gondii infection may trigger anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis in children. Prompt diagnosis and treatment of toxoplasmosis led to substantial recovery, highlighting a novel association.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Immunology

Background:

  • Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a significant autoimmune condition in children.
  • Infectious agents are increasingly implicated as triggers for anti-NMDAR encephalitis.

Observation:

  • A 9-year-old girl presented with seizures, headaches, vomiting, and behavioral changes.
  • Initial diagnostics, including CSF and MRI, were normal, but later CSF revealed lymphocytic pleocytosis and positive anti-NMDAR antibodies.
  • Toxoplasma gondii IgM and IgG were positive, while other pathogens were negative.

Findings:

  • The patient was diagnosed with anti-NMDAR encephalitis associated with acute acquired toxoplasma gondii infection.
  • Treatment with azithromycin for toxoplasmosis resulted in substantial clinical recovery without immunotherapy.
  • Complete symptom resolution occurred within two months, with decreasing toxoplasma antibody titers.

Implications:

  • This case suggests a previously unreported association between acquired toxoplasma gondii infection and anti-NMDAR encephalitis in children.
  • Clinicians should consider screening for toxoplasmosis in pediatric patients diagnosed with anti-NMDAR encephalitis.
  • Early identification and management of toxoplasmosis may be crucial for favorable outcomes in associated anti-NMDAR encephalitis.

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