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Related Experiment Video

Updated: Nov 22, 2025

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HSV encephalitis triggered anti-NMDAR encephalitis: a case report.

Shiyu Hu1, Tao Lan2, Runtao Bai1

  • 1Neurology Department of Shenzhen Second People's Hospital/First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, 518035, China.

Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
|January 9, 2021
PubMed
Summary

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis can develop early after herpes simplex virus encephalitis. A second course of IVIG treatment effectively managed persistent symptoms in a young woman.

Keywords:
Anti-NMDA receptor encephalitisHerpes simplex encephalitisRepeated intravenous immunoglobulin therapy

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Area of Science:

  • Neurology
  • Immunology
  • Infectious Diseases

Background:

  • Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a significant cause of nonviral encephalitis.
  • Herpes simplex virus (HSV) infection can trigger anti-NMDAR encephalitis (AE), with previous studies noting antibody development in 27% of herpes simplex encephalitis (HSE) patients within 3 months.
  • Standard immunotherapy may not fully resolve symptoms in all cases.

Observation:

  • A 23-year-old woman presented with seizures, psychiatric symptoms, and cognitive deficits following a suspected HSE diagnosis.
  • Anti-NMDAR antibodies were detected on day 11 post-onset, despite initial acyclovir treatment.
  • Initial immunotherapy with IVIG and methylprednisolone led to partial improvement but was followed by a seizure recurrence.

Findings:

  • The patient developed anti-NMDAR antibodies earlier than previously reported in adult HSE cases.
  • A second course of IVIG therapy resulted in significant symptom control and mild residual cognitive deficits at 1-year follow-up.
  • This case highlights the potential for early anti-NMDAR antibody development post-HSE.

Implications:

  • Simultaneous testing for AE antibodies alongside CSF analysis is recommended for early diagnosis.
  • A second course of IVIG is a viable treatment option for AE when initial immunotherapy is insufficient.
  • Understanding the temporal dynamics of antibody development in HSE is crucial for timely and effective treatment strategies.