Case report of anti-AMPA2 receptor antibody encephalitis after herpes simplex virus encephalitis in child / 中华实用儿科临床杂志

ABSTRACT

The clinical data of a child with anti-(α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid, AMPA2) receptor antibody encephalitis after herpes simplex encephalitis was retrospectively analyzed.The child was a 9-year-old female developing abnormal mental behavior after fever.The auxiliary examination of the first hospital displayed, cerebrospinal fluid sugar qualitative (+ ), white blood cell count 32×10 6/L, albumin measurement (immune turbidity method) 317.00 mg/L, immunoglobulin IgG 45.80 mg/L.Herpes simplex virus (+ ). Skull magnetic resonance imaging showed abnormal signal at the top of the frontal frontotemporal, considering intracranial infection.Video electroencephalogram the background is diffuse slow wave, a small amount of multifocal spikes, sharp waves, spine slow wave release, left frontal, and temporal sacral protrusions.One partial seizure may be detected during the awake period.The diagnosis was " herpes simplex virus encephalitis" , and the body temperature of the child returned to normal after anti-infection and hormone therapy.However, there were still cognitive impairments, irritability, and no language communication.After 2 years, there was no abnormality in routine biochemical and viral cerebrospinal fluid examination.Serum and cerebrospinal fluid autoimmune encephalitis-related antibody spectrum anti-NMDA, AMPA1/2, GABAB receptor antibody and anti-CASPR2, LGI1 antibodies were negative in serum.The anti-AMPA2 receptor antibody in the cerebrospinal fluid was weakly positive, and the final diagnosis was anti-AMPA2 receptor antibody encephalitis.After the application of hormones, the children′s cognition improved, mood was more stable than before, and language communication improved as well.Anti-AMPA2 receptor antibody encephalitis can be observed in children, and may be related to immune response after viral infection.For patients of viral encephalitis with poor treatment or disease relapse and progression, the possibility of autoimmune encephalitis should be considered.