Encephalitis on deployment in Kenya: think beyond the infections

Area of Science:

• Neuroimmunology
• Tropical Medicine
• Oncology

Background:

• Autoimmune encephalitis presents diagnostic challenges, particularly in deployed military personnel.
• Encephalitis symptoms like fever and behavioral changes can mimic infectious diseases endemic to tropical regions.

Observation:

• A female soldier deployed in Kenya presented with fever and behavioral changes, diagnosed with encephalitis.
• Standard microbiology tests for East African endemic infections were negative.
• Autoantibody screening revealed antibodies against the N-methyl-D-aspartate receptor (NMDAR).

Findings:

• The patient was diagnosed with limbic encephalitis and an ovarian teratoma.
• The condition was identified as ovarian teratoma-associated anti-NMDAR encephalitis.
• Ovarian teratoma-associated anti-NMDAR encephalitis is a potentially fatal autoimmune disorder.

Implications:

• This case underscores the importance of considering autoimmune encephalitis in febrile patients with neurological symptoms, even in tropical deployments.
• Early diagnosis and multidisciplinary management, including surgery and immunotherapy, are crucial for favorable outcomes.
• Highlights diagnostic challenges for military medical personnel operating in resource-limited or geographically diverse environments.