A Case of Mania with Malignant Catatonia due to Non Para Neoplastic Anti-NMethyl- 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 a neurological disorder in psychiatry costume. Disparity in clinical symptoms and nonsupportive laboratory investigations except the Cerebrospinal Fluid (CSF) analysis delays the diagnosis. We have presented with a case of 29-year-old female with psychiatric symptoms like suspiciousness, decreased sleep and boastfulness. Within a few days, the patient developed neurological symptoms like seizures and disorientation while the patient was on an antipsychotic drug along with benzodiazepines. Her symptoms worsened with autonomic instability and the patient entered into catatonic phase of the illness. We reached a positive diagnosis of anti-NMDA receptor encephalitis through CSF analysis. Patient recovered completely with the help of immunotherapy and intensive cognitive rehabilitation. This case emphasises the need of a multidisciplinary approach in the management, early detection and adequate treatment of this challenging illness for better results for patients.

Keywords

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