Autoimmune encephalitis with double positive anti-NMDAR and anti-GABABR secondary to herpes simplex virus encephalitis:A case report and literature review
10.13481/j.1671-587X.20240128
- VernacularTitle:继发于单纯疱疹病毒脑炎的抗NMDAR和抗GABABR双阳性自身免疫性脑炎1例报告及文献复习
- Author:
Zhongyan ZHAO
1
;
Zhiyu XU
;
Chanji WU
;
Eryi ZHAO
;
Dan HUANG
;
Shixiong HUANG
Author Information
1. 海南省人民医院 海南医学院附属海南医院神经内科,海南 海口 570311
- Keywords:
Herpes simplex virus encephalitis;
Anti-N-methy-D-aspartate receptor antibody;
Anti-γ-aminobutyric acid B receptor antibody;
Autoimmune encephalitis
- From:
Journal of Jilin University(Medicine Edition)
2024;50(1):236-242
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the clinical presentations and diagnostic and treatment process of one patient with autoimmune encephalitis(AE)with double positive anti-N-methyl-D-aspartate receptor(NMDAR)and anti-γ-aminobutyric acid B receptor(GABABR)secondary to herpes simplex virus encephalitis(HSVE),and to improve the clinicians'awareness of this disease.Methods:The clinical data of one AE patient with double positive anti-NMDAR and anti-GABABR secondary to HSVE were collected,the diagnostic and therapeutic processes were summarized,and the relevant literatures were reviewed.Results:The patient,a 36-year-old male,developed a headache followed by limb convulsions,and progressed to disturbed consciousness.After admission,the routine biochemistry of the cerebrospinal fluid(CSF)was abnormal,and the herpes simplex virus-1(HSV-1)IgG antibody showed positive in the CSF;both CSF and serum tests for NMDAR antibodies were positive;the head magnetic resonance imaging(MRI)results showed abnormal signals in the right occipital white matter,leading to the diagnosis of HSVE secondary to anti-NMDAR encephalitis.Several months later,the patient experienced psychiatric behavior abnormalities,cognitive dysfunction,and sleep disorders,and both the serum NMDAR and GABABR antibodies showed positive results,prompting the diagnosis of HSVE secondary anti-NMDAR encephalitis and anti-GABABR encephalitis.After treatment with steroid pulse therapy and intravenous immunoglobulin(IVIG),the patient's condition was improved and the patient was discharged.At one-year follow-up,the patient's psychiatric symptoms had completely resolved,leaving mild cognitive impairment.Conclusion:If the clinical symptoms of the patients recovering from antiviral treatment for HSVE is worsened,secondary AE should be highly suspected;it is important to complete autoimmunity antibody testing as soon as possible for the early diagnosis and treatment to improve the prognosis of the patient.
