Journal Article

HSV encephalitis-induced anti-NMDAR encephalitis in a 67-year-old woman: report of a case and review of the literature

Linnoila, Jenny, Cho, Tracey, Morris, Nicholas A., Kaplan, Tamara B.

2016

Overview

Herpes simplex virus (HSV) encephalitis can induce an autoimmune encephalitis mediated by autoantibodies against the N-methyl-D-aspartate receptor (NMDAR). Post-HSV NMDAR encephalitis and de novo NMDAR encephalitis have been more commonly described in children and young adults. We describe the case of a 67-year-old woman with post-HSV NMDAR encephalitis and review the relevant literature. Clinical, serological, neurophysiological, and imaging evaluations were undertaken in the evaluation of this patient. A literature review was performed. Nearly 2 months after a typical course of HSV encephalitis confirmed by HSV polymerase chain reaction studies from the spinal fluid and treated with intravenous acyclovir, a 67-year-old woman suffered neurological deterioration. There was no evidence of active HSV infection, but NMDAR antibodies were found in her serum and spinal fluid. The patient improved after initiation of immunosuppressive therapy. All patients who experience new or recurrent neurological symptoms following recovery from HSV encephalitis should be evaluated for post-infectious autoimmune encephalitis, including NMDAR encephalitis.

• Publisher: Springer US,Nature Publishing Group
• Subject: Acyclovir / Acyclovir - therapeutic use / Aged / Anti-N-Methyl-D-Aspartate Receptor Encephalitis - drug therapy / Anti-N-Methyl-D-Aspartate Receptor Encephalitis - etiology / Anti-N-Methyl-D-Aspartate Receptor Encephalitis - pathology / Anti-N-Methyl-D-Aspartate Receptor Encephalitis - virology / Antibodies / Antiviral Agents - therapeutic use / Autoantibodies / Autoantibodies - cerebrospinal fluid / Biomedical and Life Sciences / Biomedicine / Biopsy / Blood / Case reports / Cerebrospinal fluid / Clinical Review / Convulsions & seizures / DNA-Directed DNA Polymerase - cerebrospinal fluid / DNA-Directed DNA Polymerase - genetics / Encephalitis / Encephalitis, Herpes Simplex - complications / Encephalitis, Herpes Simplex - drug therapy / Encephalitis, Herpes Simplex - pathology / Encephalitis, Herpes Simplex - virology / Female / Gene Expression / Glutamate receptors / Herpes simplex / Herpes viruses / Humans / Immunoglobulins, Intravenous - therapeutic use / Immunology / Immunosuppressive agents / Immunosuppressive Agents - therapeutic use / Infections / Infectious Diseases / Leukocytes / Literature reviews / Magnetic resonance imaging / N-Methyl-D-aspartic acid receptors / Neurology / Neurosciences / Pathogenesis / Patients / Personality / Rituximab - therapeutic use / Simplexvirus - genetics / Simplexvirus - growth & development / Simplexvirus - pathogenicity / Steroids / Viral Proteins - cerebrospinal fluid / Viral Proteins - genetics / Virology / Young adults