Mania with malignant catatonia due to nonpara neoplastic Anti-N-methyl-D-aspartate-Receptor encephalitis in a 29-year-old female – A rare entity

Abstract

Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is a rare neurological autoimmune encephalitis. Its symptoms may mimic psychosis as this disease is neurological disorder in psychiatric costume. Disparity in clinical symptoms and nonsupportive laboratory investigations except the cerebrospinal fluid (CSF) analysis delays the diagnosis. We presented a case of 29-year-old female with psychiatric symptoms such as suspiciousness, decreased sleep, and boastfulness. Within few days, the patient developed neurological symptoms like seizures, disorientation, while the patient was on antipsychotic and benzodiazepines. Her symptoms worsened and the patient entered into the catatonic phase of the illness along with autonomic instability. We reached a positive diagnosis of Anti-NMDA encephalitis through CSF analysis. The patient recovered completely with the help of immunotherapy and intensive cognitive rehabilitation. This case emphasizes the need of a multidisciplinary approach in the management, early detection, and adequate treatment of this challenging illness for the better outcome of the patient.

Keywords

• anti-n-methyl-d-aspartate encephalitis
• cerebrospinal fluid analysis
• immunotherapy
• malignant catatonia
• neuropsychiatric