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Case Report: Anti-N-Methyl-D-Aspartate Receptor Encephalitis Manifesting With an Isolated Psychiatric Episode and Normal Ancillary Tests

The majority of patients with anti-N-Methyl-D-Aspartate receptor (NMDAR) encephalitis present with psychiatric symptoms and subsequently develop neurological features. However, isolated psychiatric episodes occur in <5% of affected individuals, less frequent at disease onset (<1%) compared to...

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Autores principales: Pavǎl, Denis, Cîmpan, Claudia Mihaela, Gherghel, Nicoleta, Damian, Laura Otilia, Tohǎnean, Nicoleta, Micluţia, Ioana Valentina
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9201108/
https://www.ncbi.nlm.nih.gov/pubmed/35722579
http://dx.doi.org/10.3389/fpsyt.2022.905088
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author Pavǎl, Denis
Cîmpan, Claudia Mihaela
Gherghel, Nicoleta
Damian, Laura Otilia
Tohǎnean, Nicoleta
Micluţia, Ioana Valentina
author_facet Pavǎl, Denis
Cîmpan, Claudia Mihaela
Gherghel, Nicoleta
Damian, Laura Otilia
Tohǎnean, Nicoleta
Micluţia, Ioana Valentina
author_sort Pavǎl, Denis
collection PubMed
description The majority of patients with anti-N-Methyl-D-Aspartate receptor (NMDAR) encephalitis present with psychiatric symptoms and subsequently develop neurological features. However, isolated psychiatric episodes occur in <5% of affected individuals, less frequent at disease onset (<1%) compared to relapse (4%). We report the case of a previously healthy 24-year-old female who presented with psychotic symptoms and behavioral alterations. Despite therapy, she showed no improvement and subsequently developed catatonic features. While the ancillary tests were normal, the clinical warning signs raised the suspicion of anti-NMDAR encephalitis which we later confirmed. Given its strong association with underlying tumors, we screened the patient and found an ovarian teratoma. Once removed, the patient displayed a substantial improvement in the mental status. Besides being extremely rare, this case illustrates the need to maintain clinical suspicion of anti-NMDAR encephalitis even in the absence of neurological features or paraclinical anomalies.
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spelling pubmed-92011082022-06-17 Case Report: Anti-N-Methyl-D-Aspartate Receptor Encephalitis Manifesting With an Isolated Psychiatric Episode and Normal Ancillary Tests Pavǎl, Denis Cîmpan, Claudia Mihaela Gherghel, Nicoleta Damian, Laura Otilia Tohǎnean, Nicoleta Micluţia, Ioana Valentina Front Psychiatry Psychiatry The majority of patients with anti-N-Methyl-D-Aspartate receptor (NMDAR) encephalitis present with psychiatric symptoms and subsequently develop neurological features. However, isolated psychiatric episodes occur in <5% of affected individuals, less frequent at disease onset (<1%) compared to relapse (4%). We report the case of a previously healthy 24-year-old female who presented with psychotic symptoms and behavioral alterations. Despite therapy, she showed no improvement and subsequently developed catatonic features. While the ancillary tests were normal, the clinical warning signs raised the suspicion of anti-NMDAR encephalitis which we later confirmed. Given its strong association with underlying tumors, we screened the patient and found an ovarian teratoma. Once removed, the patient displayed a substantial improvement in the mental status. Besides being extremely rare, this case illustrates the need to maintain clinical suspicion of anti-NMDAR encephalitis even in the absence of neurological features or paraclinical anomalies. Frontiers Media S.A. 2022-06-02 /pmc/articles/PMC9201108/ /pubmed/35722579 http://dx.doi.org/10.3389/fpsyt.2022.905088 Text en Copyright © 2022 Pavǎl, Cîmpan, Gherghel, Damian, Tohǎnean and Micluţia. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Psychiatry
Pavǎl, Denis
Cîmpan, Claudia Mihaela
Gherghel, Nicoleta
Damian, Laura Otilia
Tohǎnean, Nicoleta
Micluţia, Ioana Valentina
Case Report: Anti-N-Methyl-D-Aspartate Receptor Encephalitis Manifesting With an Isolated Psychiatric Episode and Normal Ancillary Tests
title Case Report: Anti-N-Methyl-D-Aspartate Receptor Encephalitis Manifesting With an Isolated Psychiatric Episode and Normal Ancillary Tests
title_full Case Report: Anti-N-Methyl-D-Aspartate Receptor Encephalitis Manifesting With an Isolated Psychiatric Episode and Normal Ancillary Tests
title_fullStr Case Report: Anti-N-Methyl-D-Aspartate Receptor Encephalitis Manifesting With an Isolated Psychiatric Episode and Normal Ancillary Tests
title_full_unstemmed Case Report: Anti-N-Methyl-D-Aspartate Receptor Encephalitis Manifesting With an Isolated Psychiatric Episode and Normal Ancillary Tests
title_short Case Report: Anti-N-Methyl-D-Aspartate Receptor Encephalitis Manifesting With an Isolated Psychiatric Episode and Normal Ancillary Tests
title_sort case report: anti-n-methyl-d-aspartate receptor encephalitis manifesting with an isolated psychiatric episode and normal ancillary tests
topic Psychiatry
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9201108/
https://www.ncbi.nlm.nih.gov/pubmed/35722579
http://dx.doi.org/10.3389/fpsyt.2022.905088
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