ArticleEncephalitis (Seoul, Korea)2025
A case report of anti-N-methyl-ᴅ-aspartate receptor encephalitis: prioritizing clinical symptoms over diagnostic test results.
Article in Encephalitis (Seoul, Korea), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Anti-N-methyl-ᴅ-aspartate receptor (NMDAR) encephalitis is the most common type of autoimmune encephalitis; however, the frequently negative initial diagnostic test results for NMDAR complicate its diagnosis. A 40-year-old man with no underlying medical conditions presented with psychiatric symptoms lasting 3 weeks; initial cerebrospinal fluid (CSF) examination, brain magnetic resonance imaging, and electroencephalography findings demonstrated no significant abnormalities. He subsequently developed symptoms characteristic of anti-NMDAR encephalitis, prompting the initiation of immunotherapy before the presence of CSF anti-NMDAR antibodies was confirmed. After receiving intravenous immunoglobulin (IVIG) followed by rituximab therapy, his symptoms improved dramatically. He was discharged 21 days after hospital admission in a healthy condition. The presence of CSF anti-NMDAR antibodies was confirmed post-discharge. This case highlights the importance of maintaining autoimmune encephalitis as a differential diagnosis in cases with similar presentations and in which initial test results identify no abnormalities. In these cases, clinical diagnoses and responses to therapy should supersede diagnostic test findings.
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