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Anti-N-methyl-D-aspartate receptor encephalitis associated with reactivated Epstein-Barr virus infection in pediatric

Ruolin Hou1, Jing Wu, Dake He

  • 1Department of Pediatric Neurology, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.

Medicine
|May 18, 2019
PubMed
Abstract

Insights

Reactivated Epstein-Barr virus (EBV) infection may trigger anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis in children. Prompt diagnosis and treatment led to substantial recovery in three pediatric cases.

Area of Science:

  • Pediatric Neurology
  • Infectious Diseases
  • Immunology

Background:

  • Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a significant autoimmune neurological disorder in children, presenting with diverse clinical manifestations.
  • While various infections can trigger anti-NMDAR encephalitis, the role of Epstein-Barr virus (EBV) reactivation has not been previously established in pediatric cases.

Observation:

  • Three pediatric patients presented with severe neurological symptoms including seizures, altered mental status, and movement disorders.
  • Diagnostic investigations confirmed the presence of anti-NMDAR antibodies in cerebrospinal fluid (CSF) and evidence of active Epstein-Barr virus (EBV) infection, indicated by positive EBV-early antigen (EA)-IgG in CSF and serum antibodies.

Findings:

  • The cases were diagnosed as anti-NMDAR encephalitis associated with reactivated EBV infection.
  • Treatment involving immunoglobulin, corticosteroids, and antiviral agents resulted in substantial clinical recovery for all three patients.
  • Post-treatment CSF analysis revealed a significant decrease in anti-NMDAR antibody titers, correlating with clinical improvement.

Implications:

  • This study suggests that reactivated Epstein-Barr virus (EBV) infection is a potential trigger for anti-NMDAR encephalitis in children.
  • The findings underscore the importance of including virological testing for EBV in the diagnostic workup of pediatric autoimmune encephalitis.
  • Early identification and management of EBV-associated anti-NMDAR encephalitis can lead to favorable patient outcomes.

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