Meningitis as early manifestation of anti-NMDAR encephalitis

ABSTRACT

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a recently discovered immune mediated encephalitis. The syndrome typically occurs in children and young adult with initial presentations of psychiatric symptoms, seizures, followed by abnormal movement and dysautonomia. There is association with ovarian teratoma. We report here a 16-year-old girl with anti-NMDAR encephalitis, who present with meningitis as initial symptom, confirmed by pleocytosis in the cerebrospinal fluid and leptomeningeal enhancement in MRI. She subsequently manifested the more typical manifestations of oro-facial dyskinesia and choreoathetosis. The diagnosis was confirmed by the presence of antiNMDAR antibody. She was treated with immunotherapy with clinical improvement and drop in the level of autoantibody. However the patient died due to septisemia.