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Anti-N-methyl-D-aspartate receptor encephalitis with serum anti-thyroid antibodies and IgM antibodies against Epstein-Barr virus viral capsid antigen: a case report and one year follow-up.
BMC Neurol. 2011 Nov 29; 11:149.BN

Abstract

BACKGROUND

Anti-N-methyl-D-aspartate receptor encephalitis is an increasingly common autoimmune disorder mediated by antibodies to certain subunit of the N-methyl-D-aspartate receptor. Recent literatures have described anti-thyroid and infectious serology in this encephalitis but without follow-up.

CASE PRESENTATION

A 17-year-old Chinese female patient presented with psychiatric symptoms, memory deficits, behavioral problems and seizures. She then progressed through unresponsiveness, dyskinesias, autonomic instability and central hypoventilation during treatment. Her conventional blood work on admission showed high titers of IgG antibodies to thyroglobulin, thyroid peroxidase and IgM antibodies to Epstein-Barr virus viral capsid antigen. An immature ovarian teratoma was found and removal of the tumor resulted in a full recovery. The final diagnosis of anti-N-methyl-D-aspartate receptor encephalitis was made by the identification of anti-N-methyl-D-aspartate receptor antibodies in her cerebral spinal fluid. Pathology studies of the teratoma revealed N-methyl-D-aspartate receptor subunit 1 positive ectopic immature nervous tissue and Epstein-Barr virus latent infection. She was discharged with symptoms free, but titers of anti-thyroid peroxidase and anti-thyroglobulin antibodies remained elevated. One year after discharge, her serum remained positive for anti-thyroid peroxidase and anti-N-methyl-D-aspartate receptor antibodies, but negative for anti-thyroglobulin antibodies and IgM against Epstein-Barr virus viral capsid antigen.

CONCLUSIONS

Persistent high titers of anti-thyroid peroxidase antibodies from admission to discharge and until one year later in this patient may suggest a propensity to autoimmunity in anti- N-methyl-D-aspartate receptor encephalitis and support the idea that neuronal and thyroid autoimmunities represent a pathogenic spectrum. Enduring anti-N-methyl-D-aspartate receptor antibodies from admission to one year follow-up but seroreversion of Epstein-Barr virus viral capsid antigen IgM may raise the important issue of elucidating the triggers and boosters of anti- N-methyl-D-aspartate receptor encephalitis.

Authors+Show Affiliations

Department of Neurology, Beijing Friendship Hospital, Capital Medical University, No,95 Yong'An Road, Beijing, 100050, China. xchling@yahoo.cnNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22126669

Citation

Xu, Chun-Ling, et al. "Anti-N-methyl-D-aspartate Receptor Encephalitis With Serum Anti-thyroid Antibodies and IgM Antibodies Against Epstein-Barr Virus Viral Capsid Antigen: a Case Report and One Year Follow-up." BMC Neurology, vol. 11, 2011, p. 149.
Xu CL, Liu L, Zhao WQ, et al. Anti-N-methyl-D-aspartate receptor encephalitis with serum anti-thyroid antibodies and IgM antibodies against Epstein-Barr virus viral capsid antigen: a case report and one year follow-up. BMC Neurol. 2011;11:149.
Xu, C. L., Liu, L., Zhao, W. Q., Li, J. M., Wang, R. J., Wang, S. H., Wang, D. X., Liu, M. Y., Qiao, S. S., & Wang, J. W. (2011). Anti-N-methyl-D-aspartate receptor encephalitis with serum anti-thyroid antibodies and IgM antibodies against Epstein-Barr virus viral capsid antigen: a case report and one year follow-up. BMC Neurology, 11, 149. https://doi.org/10.1186/1471-2377-11-149
Xu CL, et al. Anti-N-methyl-D-aspartate Receptor Encephalitis With Serum Anti-thyroid Antibodies and IgM Antibodies Against Epstein-Barr Virus Viral Capsid Antigen: a Case Report and One Year Follow-up. BMC Neurol. 2011 Nov 29;11:149. PubMed PMID: 22126669.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anti-N-methyl-D-aspartate receptor encephalitis with serum anti-thyroid antibodies and IgM antibodies against Epstein-Barr virus viral capsid antigen: a case report and one year follow-up. AU - Xu,Chun-Ling, AU - Liu,Lei, AU - Zhao,Wei-Qin, AU - Li,Ji-Mei, AU - Wang,Rui-Jin, AU - Wang,Shu-Hui, AU - Wang,De-Xin, AU - Liu,Mei-Yun, AU - Qiao,Shan-Shan, AU - Wang,Jia-Wei, Y1 - 2011/11/29/ PY - 2011/08/07/received PY - 2011/11/29/accepted PY - 2011/12/1/entrez PY - 2011/12/1/pubmed PY - 2012/3/7/medline SP - 149 EP - 149 JF - BMC neurology JO - BMC Neurol VL - 11 N2 - BACKGROUND: Anti-N-methyl-D-aspartate receptor encephalitis is an increasingly common autoimmune disorder mediated by antibodies to certain subunit of the N-methyl-D-aspartate receptor. Recent literatures have described anti-thyroid and infectious serology in this encephalitis but without follow-up. CASE PRESENTATION: A 17-year-old Chinese female patient presented with psychiatric symptoms, memory deficits, behavioral problems and seizures. She then progressed through unresponsiveness, dyskinesias, autonomic instability and central hypoventilation during treatment. Her conventional blood work on admission showed high titers of IgG antibodies to thyroglobulin, thyroid peroxidase and IgM antibodies to Epstein-Barr virus viral capsid antigen. An immature ovarian teratoma was found and removal of the tumor resulted in a full recovery. The final diagnosis of anti-N-methyl-D-aspartate receptor encephalitis was made by the identification of anti-N-methyl-D-aspartate receptor antibodies in her cerebral spinal fluid. Pathology studies of the teratoma revealed N-methyl-D-aspartate receptor subunit 1 positive ectopic immature nervous tissue and Epstein-Barr virus latent infection. She was discharged with symptoms free, but titers of anti-thyroid peroxidase and anti-thyroglobulin antibodies remained elevated. One year after discharge, her serum remained positive for anti-thyroid peroxidase and anti-N-methyl-D-aspartate receptor antibodies, but negative for anti-thyroglobulin antibodies and IgM against Epstein-Barr virus viral capsid antigen. CONCLUSIONS: Persistent high titers of anti-thyroid peroxidase antibodies from admission to discharge and until one year later in this patient may suggest a propensity to autoimmunity in anti- N-methyl-D-aspartate receptor encephalitis and support the idea that neuronal and thyroid autoimmunities represent a pathogenic spectrum. Enduring anti-N-methyl-D-aspartate receptor antibodies from admission to one year follow-up but seroreversion of Epstein-Barr virus viral capsid antigen IgM may raise the important issue of elucidating the triggers and boosters of anti- N-methyl-D-aspartate receptor encephalitis. SN - 1471-2377 UR - https://www.unboundmedicine.com/medline/citation/22126669/Anti_N_methyl_D_aspartate_receptor_encephalitis_with_serum_anti_thyroid_antibodies_and_IgM_antibodies_against_Epstein_Barr_virus_viral_capsid_antigen:_a_case_report_and_one_year_follow_up_ L2 - https://bmcneurol.biomedcentral.com/articles/10.1186/1471-2377-11-149 DB - PRIME DP - Unbound Medicine ER -