A case report of adolescent anti-NMDAR encephalitis with depressive symptoms (eng)

Abstract

Clinical presentation of anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis includes both neurological and psychiatric symptoms, and it is diagnosed with autoantibodies against the GluN1 subunit of NMDAR. The clinical presentation has a wide range of non-specific symptoms such as rapidly progressing psychiatric symptoms, cognitive impairment, seizures, and abnormal movements. The fact that mental and behavioural symptoms play an important role in the course of this rare clinical disorder complicates the differential diagnosis with psychiatric disorders and may lead to a delay in treatment. This case report presents the diagnostic process, treatment, and follow-up of an adolescent diagnosed with anti-NMDAR encephalitis. Neurological examination of a 15-year-old adolescent girl with sudden onset of contractions in the trunk and extremities were within normal limits when her symptoms started. Sertraline was prescribed since these were considered to be associated with new-onset depressive symptoms. She was admitted to the emergency department because of her exacerbated facial dyskinesias after using sertraline for one week. During clinical follow-up of the patient, no psychotic findings were observed, but amnesia, cognitive slowing, suicide attempts, and physical aggression were psychiatric symptoms that were difficult to manage. Psychiatric symptoms improve after switching to rituximab and regressed totally, still asymptomatic in the second year of treatment. Anti-NMDAR encephalitis usually occurs in adolescence and young adulthood. Psychiatric symptoms complicate the diagnosis. Since early intervention is a positive prognostic marker, it is important to raise clinician awareness of this particular clinical picture.

Keywords

• adolescent
• anti-nmdar
• encephalitis
• neuropsychiatry
• psychiatric disorder
• mental health
• rituximab.