Abstract
BackgroundMeningitis is a very rare atypical presenting feature of anti-NMDA receptor encephalitis. In our case report, we describe an unusual clinical presentation of anti-NMDA receptor encephalitis with a biphasic pattern of meningitis followed by encephalitis and discuss potential mechanisms underlying this presentation. We aim to widen the differential diagnosis to be considered in a patient presenting with clinical meningitis and pyrexia.Case presentationThis is a case of a 33-year old Caucasian woman who initially presented with a lymphocytic meningitis attributed to a viral infection. She subsequently developed fluctuating consciousness, agitation, visual hallucinations, dyskinetic movements, a generalized tonic-clonic seizure, and autonomic instability. Investigations revealed a diagnosis of anti-NMDA receptor encephalitis secondary to a previously unidentified ovarian teratoma. She made an excellent recovery with immunotherapy and removal of the teratoma.ConclusionClinicians should consider autoimmune encephalitides in individuals with meningitis, particularly where extensive investigations fail to identify a causative pathogen and there is rapid development of an encephalitic phenotype.
Highlights
Meningitis is a very rare atypical presenting feature of anti-NMDA receptor encephalitis
Anti-NMDA receptor encephalitis is a well-recognised immunotherapy-responsive condition which often occurs as a paraneoplastic phenomenon
We present a case of a 33-year old Caucasian woman who initially presented with a lymphocytic meningitis attributed to a viral infection, but who subsequently developed clinical and investigative features consistent with anti-NMDA receptor encephalitis
Summary
Meningitis is a very rare atypical presenting feature of anti-NMDA receptor encephalitis. Case presentation: This is a case of a 33-year old Caucasian woman who initially presented with a lymphocytic meningitis attributed to a viral infection. She subsequently developed fluctuating consciousness, agitation, visual hallucinations, dyskinetic movements, a generalized tonic-clonic seizure, and autonomic instability. Investigations revealed a diagnosis of anti-NMDA receptor encephalitis secondary to a previously unidentified ovarian teratoma. Meningitis is a very rare presenting feature of anti-NMDA receptor encephalitis with our literature search only revealing one other reported case. We present a case of a 33-year old Caucasian woman who initially presented with a lymphocytic meningitis attributed to a viral infection, but who subsequently developed clinical and investigative features consistent with anti-NMDA receptor encephalitis. She was treated empirically with intravenous acyclovir 10 mg/kg three times a day pending her CSF virology polymerase
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
