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AKU Student

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Document Type

Case Report

Abstract

Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a form of autoimmune encephalitis that predominantly affects young individuals and often presents with neuropsychiatric symptoms. It is frequently misdiagnosed as a primary psychiatric disorder due to its initial presentation. Although first-line immunotherapy typically includes corticosteroids, intravenous immunoglobulin (IVIG), or plasmapheresis, a subset of patients shows limited response and requires escalation to second-line agents such as Rituximab. We report two adult male patients, aged 35 and 41 years, who initially presented with behavioral disturbances, confusion, memory deficits, and speech abnormalities. Both were initially misdiagnosed with psychiatric illnesses, delaying appropriate treatment. Diagnostic workups including MRI, EEG, and cerebrospinal fluid analysis were unremarkable; however, both patients tested positive for anti-NMDAR antibodies in serum and CSF. First-line immunotherapy with methylprednisolone and IVIG failed to yield significant improvement. Rituximab was subsequently initiated, leading to substantial clinical recovery in both cases. One patient experienced steroid-induced psychosis, which was resolved with psychiatric management. No Rituximab-related complications were observed. These cases highlight the importance of early consideration of anti-NMDAR encephalitis in adults presenting with acute psychiatric and cognitive symptoms. Timely diagnosis and escalation to second-line therapy with Rituximab in cases unresponsive to first-line treatment can significantly improve outcomes.

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