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Anti-N-Methyl-D-Aspartate Receptor Encephalitis With Diffuse Demyelinating Plaques: A Case Report of an Atypical Presentation

Tirado-García, Luis-Angel ; Piña-Ballantyne, Steven-Andrés ; Cienfuegos-Meza, Jesús ; Tena-Suck, Martha-Lilia

Curēus (Palo Alto, CA), 2023-07, Vol.15 (7), p.e41595 [Periódico revisado por pares]

United States: Cureus Inc

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  • Título:
    Anti-N-Methyl-D-Aspartate Receptor Encephalitis With Diffuse Demyelinating Plaques: A Case Report of an Atypical Presentation
  • Autor: Tirado-García, Luis-Angel ; Piña-Ballantyne, Steven-Andrés ; Cienfuegos-Meza, Jesús ; Tena-Suck, Martha-Lilia
  • Assuntos: Antibodies ; Antigens ; Biopsy ; Case reports ; Chemokines ; Cytokines ; Encephalitis ; Immunoglobulins ; Lymphocytes ; Magnetic resonance imaging ; Neurology ; Neurosurgery ; Pathology ; Psychosis ; Tumor necrosis factor-TNF
  • É parte de: Curēus (Palo Alto, CA), 2023-07, Vol.15 (7), p.e41595
  • Descrição: Anti-N-methyl-D-aspartate (anti-NMDA) receptor encephalitis is an autoimmune disease triggered by antibodies against the NR1 subunit of this receptor. It has a wide variety of presentations, including abnormal behavior, psychosis, seizures, abnormal movement, insomnia, and irritability. The diagnosis is confirmed by the presence of one of the six main symptoms and anti-NR1 immunoglobulin G (IgG)-positive antibodies in the cerebrospinal fluid (CSF) after the exclusion of other disorders. We present a case of an 18-year-old female with progressive paresthesia and muscle weakness that compromised walking and psychiatric symptoms. She was admitted to a private institution where magnetic resonance imaging (MRI) revealed pseudotumoral lesions, which led to surgical intervention. The original histopathological diagnosis was of a pleomorphic xanthoastrocytoma (PXA) WHO grade 2. As symptoms persisted, she was referred to our institution where a new MRI was performed, and a biopsy was re-evaluated. It showed perivascular inflammatory infiltrates composed of T cells, intense peripheral gliosis, nodules of macrophages, and reactive astrocytes in the white matter with fragmentation and vacuolation of myelin sheets, suggesting a demyelinating process in contrast to neoplasia. CSF analysis was performed, and it was positive for anti-NMDA antibodies. Immunohistochemical positivity for N-methyl-D-aspartate (NMDA) was observed in the neuronal nuclei, which led to the diagnosis.
  • Editor: United States: Cureus Inc
  • Idioma: Inglês
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