Anti-NMDA receptor encephalitis; a psychiatric manifestation of autoimmune process

Abstract

Anti-N-methyl-d-Aspartate (anti-NMDA) receptor encephalitis is an encephalitis that cause by autoimmune process and rarely found in Indonesia. The symptoms may be different from other causes of encephalitis. With predominant psychiatric symptoms such as personality changes, seizure, and movement disorders. The diagnosis of encephalitis is frequently delayed as it misdiagnosed as psychiatric problem. We reported a young woman who studied in boarding school with anti-NMDA receptor encephalitis. She got behaviour changes worsened in 4 months. Her family assumed that she was bullied by her school friends. A 13-year-old female presented with complaining of fever and behavior changes. After several days in wards she got lips smacking, spasticity, seizure, and followed by decreased consciousness. She was consult to neurologist and we found her mental status was delirium, spastic without paresis, and positive in Babinski sign. Brain CT-scan reported as early abscess in right periventricular. CSF analysis result relatively normal. Electroencephalography (EEG) showed diffuse slow wave. We checked serum anti-NMDA receptor and the result was positive. She was treated with intravenous immunoglobulin (IVIG) and methyl prednisolone as first line therapy. After completed theraphy she was discharged home and drastically improved. Anti-NMDA receptor encephalitis sometimes misdiagnosed as psychiatric problem. Detection of antibodies anti NMDA receptors in serum or CSF are important for definitive diagnose. Right diagnose will lead to responsive treatment and good prognosis.