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Case report: meningitis as a presenting feature of anti-NMDA receptor encephalitis.
BMC Infect Dis. 2020 Jan 07; 20(1):21.BI

Abstract

BACKGROUND

Meningitis is a very rare atypical presenting feature of anti-NMDA receptor encephalitis. In our case report, we describe an unusual clinical presentation of anti-NMDA receptor encephalitis with a biphasic pattern of meningitis followed by encephalitis and discuss potential mechanisms underlying this presentation. We aim to widen the differential diagnosis to be considered in a patient presenting with clinical meningitis and pyrexia.

CASE PRESENTATION

This is a case of a 33-year old Caucasian woman who initially presented with a lymphocytic meningitis attributed to a viral infection. She subsequently developed fluctuating consciousness, agitation, visual hallucinations, dyskinetic movements, a generalized tonic-clonic seizure, and autonomic instability. Investigations revealed a diagnosis of anti-NMDA receptor encephalitis secondary to a previously unidentified ovarian teratoma. She made an excellent recovery with immunotherapy and removal of the teratoma.

CONCLUSION

Clinicians should consider autoimmune encephalitides in individuals with meningitis, particularly where extensive investigations fail to identify a causative pathogen and there is rapid development of an encephalitic phenotype.

Authors+Show Affiliations

Centre of Clinical Brain Sciences, The University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK. mstavrou@ed.ac.uk. Anne Rowling Regenerative Neurology Clinic, 49 Little France Crescent, Edinburgh, EH16 4SB, UK. mstavrou@ed.ac.uk. Department of Clinical Neurosciences, Western General Hospital, Edinburgh, EH4 2XU, UK. mstavrou@ed.ac.uk.Neurology Department, Queen's Medical Centre, Nottingham, NG7 2UH, UK.Medical Education Centre, Monklands Hospital, Airdrie, ML6 0JS, UK.Regional Infectious Disease Unit, Western General Hospital, Edinburgh, EH4 2XU, UK.Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK.Centre of Clinical Brain Sciences, The University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK. Anne Rowling Regenerative Neurology Clinic, 49 Little France Crescent, Edinburgh, EH16 4SB, UK. Department of Clinical Neurosciences, Western General Hospital, Edinburgh, EH4 2XU, UK.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

31910823

Citation

Stavrou, Maria, et al. "Case Report: Meningitis as a Presenting Feature of anti-NMDA Receptor Encephalitis." BMC Infectious Diseases, vol. 20, no. 1, 2020, p. 21.
Stavrou M, Yeo JM, Slater AD, et al. Case report: meningitis as a presenting feature of anti-NMDA receptor encephalitis. BMC Infect Dis. 2020;20(1):21.
Stavrou, M., Yeo, J. M., Slater, A. D., Koch, O., Irani, S., & Foley, P. (2020). Case report: meningitis as a presenting feature of anti-NMDA receptor encephalitis. BMC Infectious Diseases, 20(1), 21. https://doi.org/10.1186/s12879-020-4761-1
Stavrou M, et al. Case Report: Meningitis as a Presenting Feature of anti-NMDA Receptor Encephalitis. BMC Infect Dis. 2020 Jan 7;20(1):21. PubMed PMID: 31910823.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Case report: meningitis as a presenting feature of anti-NMDA receptor encephalitis. AU - Stavrou,Maria, AU - Yeo,Jing Ming, AU - Slater,Alexander David, AU - Koch,Oliver, AU - Irani,Sarosh, AU - Foley,Peter, Y1 - 2020/01/07/ PY - 2019/08/15/received PY - 2019/12/31/accepted PY - 2020/1/9/entrez PY - 2020/1/9/pubmed PY - 2020/2/25/medline KW - Anti-NMDA receptor KW - Anti-NMDAR KW - Encephalitis KW - Meningitis SP - 21 EP - 21 JF - BMC infectious diseases JO - BMC Infect Dis VL - 20 IS - 1 N2 - BACKGROUND: Meningitis is a very rare atypical presenting feature of anti-NMDA receptor encephalitis. In our case report, we describe an unusual clinical presentation of anti-NMDA receptor encephalitis with a biphasic pattern of meningitis followed by encephalitis and discuss potential mechanisms underlying this presentation. We aim to widen the differential diagnosis to be considered in a patient presenting with clinical meningitis and pyrexia. CASE PRESENTATION: This is a case of a 33-year old Caucasian woman who initially presented with a lymphocytic meningitis attributed to a viral infection. She subsequently developed fluctuating consciousness, agitation, visual hallucinations, dyskinetic movements, a generalized tonic-clonic seizure, and autonomic instability. Investigations revealed a diagnosis of anti-NMDA receptor encephalitis secondary to a previously unidentified ovarian teratoma. She made an excellent recovery with immunotherapy and removal of the teratoma. CONCLUSION: Clinicians should consider autoimmune encephalitides in individuals with meningitis, particularly where extensive investigations fail to identify a causative pathogen and there is rapid development of an encephalitic phenotype. SN - 1471-2334 UR - https://www.unboundmedicine.com/medline/citation/31910823/Case_report:_meningitis_as_a_presenting_feature_of_anti_NMDA_receptor_encephalitis_ L2 - https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-020-4761-1 DB - PRIME DP - Unbound Medicine ER -