The association of herpes simplex type 1 encephalitis and anti –N methyl D aspartate receptor antibody encephalitis in a case

Year 2020, Volume: 2 Issue: 4, 152 - 155, 23.09.2020

Metin Özsoy , Ülkü Siyah , Salih Cesur , Ayşe Büyükdemirci , Cigdem Ataman Hatipoglu , Hüseyin Esmer , Selin Şenol , Gülşah Gelişigüzel , Sami Kınıklı

https://doi.org/10.38053/acmj.727660

Abstract

Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is a type of autoimmune encephalitis characterized by seizures, psychiatric symptoms, and movement disorder, which may present with an acute or subacute course. It has been reported that the production of anti-NDMA receptor antibodies can be triggered in the course of herpes simplex encephalitis and anti-NMDA receptor encephalitis may occur clinically. It has been reported that 25% of patients with HSV encephalitis have anti-NDMA receptor antibodies and are associated with impaired improvement in cognitive performance. In this article, we present a case of anti-NMDA receptor encephalitis associated with HSV-type 1 encephalitis in a 30-year-old woman and review the literature. After the patient's treatment for HSV encephalitis ended, her psychiatric symptoms such as anxiety, agitation, hallucinations and euphoria persisted and he was diagnosed with anti NMDA receptor antibodies detected in CSF. The patient was transferred to the neurology clinic and intravenous immunoglobulin treatment was started.

Keywords

Herpes simplex encephalitis, anti- NMDA receptor antibody, herpetic encephalitis diagnosis

Bir olgu nedeniyle herpes simpleks tip 1 ensefaliti ve anti-N metil-D-aspartat reseptör antikor ensefaliti birlikteliği

Abstract

Anti-N-metil-D-aspartat (NDMA) reseptör ensefaliti akut veya subakut seyir gösterebilen, nöbet, psikiyatrik semptomlar ve hareket bozukluğu ile karakterize otoimmun bir ensefalit türüdür. Herpes simpleks ensefaliti seyrinde anti-NDMA reseptör antikorlarının üretiminin tetiklenebileceği ve anti-NMDA ensefalitinin klinik olarak ortaya çıkabileceği bildirilmiştir. HSV ensefalitli hastaların %25’inde anti-NDMA reseptör antikorlarının ortaya çıktığı ve bilinçsel performasdaki iyileşmede bozulma ile ilişkili.olduğu rapor edilmiştir. Bu yazıda 30 yaşında kadın hastada HSV-tip 1 ensefaliti ile birlikte saptanan anti NMDA reseptör ensefaliti olgusu sunularak literatür gözden geçirildi. Hastanın HSV ensefalitine yönelik tedavisi bittikten sonra anksiyete, ajitasyon, halüsünasyon ve öfori gibi psikiyatrik semptomlarının devam etmesi üzerine BOS’da bakılan anti-NMDA reseptör antikorlarının pozitif saptanması ile tanı konuldu. Nöroloji kliniğine devredilen hastaya intravenöz immunglobulin tedavisi başlandı.

Keywords

Herpes simpleks ensefaliti, anti- NMDA reseptör antikoru, herpetik ensefalit tanısı

References

• 1.Topkan A, Bilen Ş, Eruyar E, Karadağ YS. Anti-NDMA reseptör ensefaliti: Bir nöropsikiyatrik antite. Düşünen Adam JPsychiatr Neurol Sci; 29; 3: 286-9.
• 2. Dalmau J, Rosenfeld MR. Paraneoplastic and autoimmune encephalitis. https://www.uptodate.com/contents/paraneoplastic-and-autoimmune-encephalitis
• 3. Westman G, Sohrabian A, Aurelius E, et al. Clinical significance of IgM and IgA class anti-NMDAR antibodies in herpes simplex encephalitis. J Clin Virol 2018; 103: 75-80.
• 4 . Dalmau J, Graus F. Antibody-Mediated Encephalitis. N Engl J Med 2018; 378: 840.
• 5. Titulaer MJ, McCracken L, Gabilondo I, et al. Late-onset anti-NMDA receptor encephalitis. Neurology 2013; 81: 1058.
• 6. Florance NR, Davis RL, Lam C, et al. Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis in children and adolescents. Ann Neurol 2009; 66: 11.
• 7. Gresa-Arribas N, Titulaer MJ, Torrents A, et al. Antibody titres at diagnosis and during follow-up of anti-NMDA receptor encephalitis: a retrospective study. Lancet Neurol 2014; 13: 167.
• 8. Dalmau J, Gleichman AJ, Hughes EG, et al. Anti-NMDA receptor encephalitis: case series and analysis of the effects of antibodies. Lancet Neurol 2008; 7: 1091-8.
• 9. Venkatesan A, Benavides DR. Autoimmune encephalitis and its relation to infection. Curr
• Neurol Neurosci Rep 2015; 15: 3.
• 10. Armangue T, Leypoldt F, Málaga I, et al. Herpes simplex virus encephalitis is a trigger of brain autoimmunity. Ann Neurol 2014; 75: 317.
• 11. Armangue T, Spatola M, Vlagea A, et al. Frequency, symptoms, risk factors, and outcomes of autoimmune encephalitis after herpes simplex encephalitis: a prospective observational study and retrospective analysis. Lancet Neurol 2018; 17: 760.
• 12. Leypoldt F, Titulaer MJ, Aguilar E, et al. Herpes simplex virus–1 encephalitis can trigger anti-NMDA receptor encephalitis: Case report. Neorology 2013; 81: 1637-9.