Anti-N-Methyl-D-Aspartate Receptor Encephalitis, A Diagnosis Not To Miss

Anti-N-methyl-D-aspartate receptor (Anti-NMDAR) encephalitis is a rare autoimmune disease, characterized by the presence of neuropsychiatric symptoms. It is sometimes mistaken for a psychiatric disorder and other times not considered in the differential diagnosis of an encephalitic process. Correct identification of this disease and prompt treatment are key for optimal recovery, which might take weeks to months. Many patients manifest severe symptoms, with depressed level of consciousness, breathing dysfunction and dysautonomia requiring admission to the Intensive Care Unit (ICU). We report the case a young male patient with anti-NMDA encephalitis who presented typical neuropsychiatric symptoms. Despite being diagnosed and treated in a timely manner, he did not respond well to first-line immunotherapy and was admitted to the ICU with neurological, respiratory, and cardiovascular dysfunction. This resulted in prolonged hospital admission and many infectious complications. Despite the severity of the disease, the patient managed to recover in the months following discharge from hospital. LEARNING POINTS: Anti-NMDAR encephalitis is a clinical entity described relatively recently, typically manifesting as a neuropsychiatric disorder and which should be in the differential diagnosis of any case of encephalitis, especially in young patients. Important prognostic factors for anti-NMDA encephalitis are lack of clinical improvement within the first four weeks of treatment and need for admission to the ICU. Anti-NMDAR encephalitis is a severe disease with good response to immunotherapy, hence the importance of a correct diagnosis. Nonetheless, recovery from severe disease may take months to years.