Anti-N-methyl-D-Aspartate (NMDA) Receptor Encephalitis– A Case Report

We report case of a 42 years old female who came with a constellation of behavioral symptoms, delirium, body stiffness, and fever for one week. Past medical history was significant for a prolonged critical care admission at an outside facility for seizures two years ago. Her examination was consistent with the diagnosis of encephalitis. Initially, she was managed as viral encephalitis based on cerebrospinal fluid analysis with a predominant lymphocytic picture. Computed tomography (CT) scan brain was normal. An electroencephalogram (EEG) revealed moderate to severe diffuse encephalopathy. During her stay at our hospital, she developed orofacial rhythmic dyskinetic movements coupled with autonomic dysfunction. Due to her predominant symptoms of encephalitis coupled with psychiatric, autonomic and dyskinetic features, she was investigated for an underlying autoimmune etiology. She was tested positive for N-methyl-D-aspartate receptor (NMDA-R) antibodies. She received four sessions of plasmapheresis and was referred to another facility where she died. NMDA-R encephalitis poses a significant diagnostic challenge to the clinicians. These cases are potentially treatable if diagnosed earlier and started on recommended treatment with plasmapheresis, intravenous immunoglobulins, pulsed steroids, and immunosuppressants. Autoimmune encephalitis is an expanding entity which is evolving with advancements in neuroimmunology.