Anti-N-Methyl-d-Aspartate Receptor Encephalitis in a Patient with Alcoholism: A Rare Case Report.

Yangyang Li,Qiuling Wang,Chuanxin Liu,Yili Wu

doi:10.3389/fpsyt.2017.00141

Abstract

Anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis, the most common type of autoimmune encephalitis, is characterized by autoantibodies against NMDA receptor. Patients with anti-NMDAR encephalitis also present with various non-specific symptoms, such as flu-like symptoms, neurological, and psychiatric manifestations. Here, we first reported a rare case of anti-NMDAR encephalitis in a 36-year-old male alcohol abuser. The patient presented with acute psychiatric symptoms with no abnormality in neuroimage examination and laboratory test results. Alcoholism was proposed as the most likely diagnosis. However, stopping alcohol drinking and symptomatic treatment were not effective, and 12 days later, the disease progressed with seizures and unconsciousness. Routine analysis of the cerebrospinal fluid (CSF) showed no abnormality. Importantly, anti-NMDA receptor antibodies were detected in his CSF, indicating that the patient has anti-NMDA receptor encephalitis. Consistently, γ-immunoglobulin therapy dramatically improved symptoms, which further confirmed the diagnosis. As anti-NMDAR encephalitis has no unique clinical characteristic and its psychiatric manifestations may overlap with the alcoholism-associated psychiatric symptoms, precaution should be taken to differentiate anti-NMDAR encephalitis from alcoholism in alcohol abusers.

Highlights

A 36-year-old male chronic alcohol abuser had presented with a series of acute psychiatric symptoms for the past 2 days after the last drinking
Anti-NMDAR encephalitis was first reported in a young woman with ovarian teratoma and later on, a major proportion of cases are associated with tumor [2]
As anti-NMDAR encephalitis has no unique characteristics and the psychiatric manifestations may overlap with the substance abuse-associated psychiatric symptoms, it is challenged to differentiate antiNMDAR encephalitis from alcoholism [4, 5]

Summary

INTRODUCTION

A 36-year-old male chronic alcohol abuser had presented with a series of acute psychiatric symptoms for the past 2 days after the last drinking Both auditory and visual hallucinations were presented in the patient, e.g., many voice saying to kill him, airplane watching him, talking and laughing to himself. On the 12th day, the patient presented with seizures, while repeated EEG and brain MRI showed no abnormality. His neurological signs were negative and routine analysis of the cerebrospinal fluid (CSF) showed no abnormality. Repeated cranial MRI and CSF examination were normal, while EEG showed diffuse slow waves It suggested that autoimmune encephalitis may be the most likely diagnosis. At 6-month follow up, the patient had no relapse of seizures and dyskinesias, while he remained addicted to alcohol and has memory impairment

BACKGROUND

Findings

DISCUSSION

CONCLUSION