Related Experiment Video

Updated: May 4, 2026

High-throughput Flow Cytometry Cell-based Assay to Detect Antibodies to N-Methyl-D-aspartate Receptor or Dopamine-2 Receptor in Human Serum
10:19

High-throughput Flow Cytometry Cell-based Assay to Detect Antibodies to N-Methyl-D-aspartate Receptor or Dopamine-2 Receptor in Human Serum

Published on: November 23, 2013

16.7K

Child Neurology: Parainfectious Anti-NMDAR Encephalitis With Anti-MOG and Anti-AQP4 Seropositivity in an Infant

Kriti Nautiyal1, Sayoni Roy Chowdhury2, Rashmi Meena2

  • 1Department of Paediatrics. Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi, India.

Neurology
|September 15, 2025
PubMed

Insights

This case report details a rare infant encephalitis with triple autoantibody positivity (anti-NMDA receptor, anti-MOG, anti-AQP4). It highlights diagnostic and therapeutic challenges in pediatric autoimmune neurological diseases.

Area of Science:

  • Pediatric Neurology
  • Neuroimmunology
  • Autoimmune Encephalitis

Background:

  • Overlap syndromes involving anti-NMDA receptor encephalitis and MOG/AQP4-mediated demyelination are increasingly recognized.
  • Autoimmune encephalitis presents diagnostic and therapeutic challenges, particularly in infants.

Purpose of the Study:

  • To report a rare case of a 7-month-old infant with concurrent anti-NMDA receptor encephalitis, anti-MOG, and anti-AQP4 antibodies.
  • To illustrate the diagnostic complexities and treatment difficulties associated with triple autoantibody positivity in pediatric autoimmune neurological disorders.

Main Methods:

  • Clinical presentation of fever, seizures, irritability, and movement disorders in an infant.
  • Cerebrospinal fluid (CSF) and serum analysis for viral pathogens and specific autoantibodies (anti-NMDA receptor, anti-MOG, anti-AQP4).
  • Administration of multi-agent immunotherapy including steroids, IVIG, rituximab, and cyclophosphamide.

Main Results:

  • The infant presented with meningoencephalitis, choreo-ballistic-dystonic movements, encephalopathy, and dysautonomia.
  • CSF was positive for parvovirus B19 and Epstein-Barr virus; serum tested positive for anti-NMDA receptor, anti-MOG, and anti-AQP4 IgG autoantibodies.
  • Despite prompt immunotherapy, the infant showed only moderate improvement and developed refractory infantile epileptic spasm syndrome.

Conclusions:

  • The coexistence of multiple autoantibodies in this infant highlights potential links to underlying disease mechanisms in autoimmune encephalitis.
  • Triple seropositivity (anti-NMDA receptor, anti-MOG, anti-AQP4 IgG) presents significant therapeutic challenges in pediatric cases.
  • This case underscores the need for comprehensive diagnostic evaluation and tailored treatment strategies for complex autoimmune neurological conditions in infants.

More Related Videos

Induction of Paralysis and Visual System Injury in Mice by T Cells Specific for Neuromyelitis Optica Autoantigen Aquaporin-409:29

Induction of Paralysis and Visual System Injury in Mice by T Cells Specific for Neuromyelitis Optica Autoantigen Aquaporin-4

Published on: August 21, 2017

11.9K
Human Serum Anti-aquaporin-4 Immunoglobulin G Detection by Cell-based Assay05:45

Human Serum Anti-aquaporin-4 Immunoglobulin G Detection by Cell-based Assay

Published on: April 5, 2019

24.1K

Related Concept Videos

Viral Meningitis01:18

Viral Meningitis

Viral meningitis is the most common form of meningitis and is often referred to as aseptic meningitis to indicate the absence of bacterial involvement. It is generally milder than bacterial meningitis, with symptoms including fever, headache, stiff neck, drowsiness, nausea, photophobia, and vomiting. Rarely, more severe manifestations or death may occur. Common causative agents include enteroviruses, particularly coxsackie A and B viruses and echoviruses, all members of the Enterovirus genus...
199
Arboviral Encephalitis01:25

Arboviral Encephalitis

Arboviral encephalitis refers to brain inflammation caused by arthropod-borne viruses, particularly those transmitted through mosquito vectors. Among these, West Nile virus (WNV), a member of the Flaviviridae family, is a significant public health concern. WNV is an enveloped, positive-sense, single-stranded RNA virus. Human infection typically begins when an infected mosquito introduces the virus into the dermis during feeding. The primary transmission cycle involves birds as amplifying hosts...
59
Bacterial Meningitis I: Introduction01:22

Bacterial Meningitis I: Introduction

Bacterial meningitis is a severe, life-threatening inflammation of the meninges, particularly the pia mater and arachnoid mater, affecting the subarachnoid space, ventricles, and cerebrospinal fluid (CSF). If untreated, it can lead to significant neurological complications or death.Causative AgentsCommon pathogens vary with age and immune status. In adults, major organisms include Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae. Streptococcus agalactiae (group B...
15
Bacterial Meningitis II: Pathophysiology01:26

Bacterial Meningitis II: Pathophysiology

Bacterial meningitis typically begins when pathogens such as Neisseria meningitidis and Streptococcus pneumoniae colonize the nasopharynx and invade the bloodstream. This process is facilitated by bacterial virulence factors, such as polysaccharide capsules, which resist phagocytosis and complement-mediated killing. Less commonly, bacteria reach the central nervous system via contiguous spread from infections like otitis media or sinusitis, through congenital or acquired dural defects, or...
24
Encephalitis l: Introduction01:19

Encephalitis l: Introduction

Encephalitis is inflammation of the brain parenchyma, most often due to infections or autoimmune processes. It presents with neuropsychiatric features such as fever, altered mental status, behavioral changes, cognitive dysfunction, seizures, focal deficits, and sometimes autonomic instability. In some cases, the meninges are also involved, resulting in meningoencephalitis.Infectious CausesInfectious encephalitis is most commonly viral but can also result from bacterial, fungal, or parasitic...
15
Encephalitis ll: Pathophysiology01:26

Encephalitis ll: Pathophysiology

Encephalitis is inflammation of the brain parenchyma caused by direct viral invasion or immune-mediated mechanisms triggered by infections or tumors. Both processes lead to neuronal injury, disrupted neurotransmission, and diverse neurological symptoms, often with overlapping clinical and pathological features.Autoimmune EncephalitisIn autoimmune encephalitis, antibodies target neuronal antigens on cell surfaces, synapses, or within neurons. A key example is anti-NMDAR encephalitis, which can...
22