A Case Report on Anti-N-Methyl-D-Aspartate Encephalitis

Aim: The case study aims to describe and evaluate the initial neuropsychiatric symptoms, therapeutic methods, and diagnostic criteria, of a 3-year-old girl who had been diagnosed with anti-N-Methyl-D-Aspartate Receptor (NMDAR) encephalitis. This case study implies the importance of early detection and treatment in pediatric autoimmune encephalitis, highlighting its diagnostic challenges and the successive use of immunotherapy and outcomes.

Presentation of Case: A 3-year-old developmentally normal girl child was brought to the hospital with C/O fever for 2 days. Following this she had seizures lasting for around 2 minutes and followed by shivering movements in the right leg for 15 minutes and then she regained consciousness after 25 minutes. CSF analysis showed pleocytosis. Serological tests (Typhoid IgM, Rapid Malaria, Scrub IgM, Dengue IgM, Japanese Encephalitis, and Herpes Simplex Virus IgM) were negative. MRI indicated diffuse encephalopathy, and EEG detected epileptic activity. Further antibody testing in serum and CSF revealed positive Anti-NMDAR antibodies. The patient was treated with amoxicillin-clavulanate(400mg), ceftriaxone(750mg), and acyclovir(130mg) intravenously initially. Once the definitive diagnosis was made, she was treated with IVIG(26g), methylprednisolone(390mg), and levetiracetam(280mg).

Discussion: Anti-N-Methyl-D-Aspartate Receptor Encephalitis is an autoimmune encephalitis characterized by complicated neuropsychiatric symptoms and immunoglobulin G (IgG) antibodies against the NR1 subunit of the NMDA receptors in the central nervous system.

Conclusion: The appropriate diagnosis and treatment of autoimmune encephalitis necessitate an organized approach. A wide range of autoantibody tests can be performed to identify or rule-out specific autoimmune causes. Patients may relapse and require appropriate follow-up care.