A case of anti–NMDA receptor encephalitis with short–term favorable outcome after early and aggressive multidisciplinary immunotherapy

Abstract

The patient was a 16–year–old female. Two weeks after the onset of fever and headache, she began to have fluctuating disturbances of consciousness, presenting monologues, and became unable to follow instructions. MRI of the head showed no abnormalities, and there was no complication of ovarian tumor as well. Based on the clinical course, we diagnosed her condition as anti–NMDA receptor encephalitis uncomplicated by tumor, and administered multidisciplinary immunotherapy with steroid pulse, plasma exchange, intravenous gamma globulin, and immunosuppressive drugs. At the most severe stage of the disease, she required intubation and deteriorated to a state requiring ICU management. However, with repeated immunotherapy from the early stage of the disease, she improved to a level with a good functional prognosis within about 2 months after the onset of consciousness disturbance. In a long–term prognostic study of anti–NMDA receptor encephalitis, 81% of patients were reported to have a good functional prognosis (mRS 0–2) after 24 months, but it took a long time for them to recover. We suggest that early and aggressive multidisciplinary immunotherapy may be successful in anti–NMDA receptor encephalitis.