Abstract
IntroductionAnti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a rare, newly defined autoimmune clinical entity that presents with atypical clinical manifestations. Most patients with anti-N-methyl-D-aspartate receptor encephalitis develop a progressive illness from psychosis into a state of unresponsiveness, with catatonic features often associated with abnormal movements and autonomic instability. This is the first report of anti-N-methyl-D-aspartate receptor encephalitis in a Greek pediatric hospital.Case presentationAn 11-year-old Greek girl presented with clinical manifestations of acute psychosis. The differential diagnosis included viral encephalitis. The presence of a tumor usually an ovarian teratoma, a common clinical finding in many patients, was excluded. Early diagnosis and prompt immunotherapy resulted in full recovery up to one year after the initial diagnosis.ConclusionAcute psychosis is a rare psychiatric presentation in children, diagnosed only after possible organic syndromes that mimic acute psychosis are excluded, including anti-N-methyl-D-aspartate receptor receptor encephalitis. Pediatricians, neurologists and psychiatrists should consider this rare clinical syndrome, in order to make an early diagnosis and instigate appropriate treatment to maximize neurological recovery.
Highlights
Anti-N-methyl-D-aspartate receptor encephalitis is a rare, newly defined autoimmune clinical entity that presents with atypical clinical manifestations
In 2007, auto-antibodies against the NMDAR were detected in these women and eight others with similar symptoms, seven of whom had ovarian teratomas [2]
We present a case of anti-NMDAR encephalitis that was diagnosed in an 11-year-old Greek girl who presented with subacute encephalopathy and psychiatric manifestations without evidence of malignancy
Summary
The diagnosis of ‘acute psychosis’ in children is rare and can be made only after possible organic causes are excluded. The differential diagnosis is broad, with viral encephalitis being the most likely alternative cause in these circumstances. Once specific anti-NMDAR antibodies are detected, it is crucial to start correct treatment, including tumor removal and intense immunotherapy, immediately. This disease has a good prognosis in the majority of cases if diagnosed early and treated properly. PM, MM, SK, AT, CV, EK, LS and SM were involved in the initial diagnosis and management. CLS was involved in the process of drafting and revising the manuscript. All authors have read and approved the final manuscript. Consent Written informed consent was obtained from the patient’s parents for publication of this manuscript and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal
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