Two Cases of Late-Onset Anti-NMDAr Auto-Immune Encephalitis After Herpes Simplex Virus 1 Encephalitis

Frontiers in Neurology
Guillaume DorcetJérémie Pariente

Abstract

Context: Encephalitis due to herpes simplex virus 1 (HSV-1) was described as a potential trigger for the development of anti-N-methyl-D-aspartate receptor (NMDAr) auto-immune encephalitis (AIE) within a few days to a few weeks after the infection. Methods: We assessed clinical, radiological, and biological diagnoses process, treatment response, and evolution. Cases Reported: We report here cases of a 71-year-old man and a 57-year-old woman presenting anti-NMDAr AIE, respectively, 12 and 7 months after HSV-1 encephalitis. In both cases, the onset was brisk, and the symptoms were mainly neuropsychiatric (paranoid delirium, Capgras, and Cotard syndromes) and cognitive, with anterograde amnesia. Relapse of HSV encephalitis, epilepsy, and paraneoplastic neurologic syndromes were excluded. The clinical response to first-line treatments composed of intravenous immunoglobulins and high-dose corticosteroids was poor, whereas significant improvement was noticed after rituximab induction. Conclusion: Post-herpetic anti-NMDAr AIE could arise several months after infection. Clinicians must be aware of this possibility, particularly if cognitive and/or psychiatric symptoms occurred after a remitting period. In our two cases, only rituximab w...Continue Reading

References

Aug 1, 1994·Journal of Neurology, Neurosurgery, and Psychiatry·M AnderssonM Grønning
Nov 8, 2014·Neurology·Wolf-Rüdiger SchäbitzChristian G Bien
Feb 1, 2015·Current Neurology and Neuroscience Reports·Arun Venkatesan, David R Benavides
Oct 23, 2015·Neurology·Thaís ArmangueUNKNOWN Spanish Prospective Multicentric Study of Autoimmunity in Herpes Simplex Encephalitis
Feb 27, 2016·The European Journal of Neuroscience·Aude ChefdevilleVirginie Desestret

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Citations

May 18, 2020·Annals of Neurology·Andrea PilottoAlessandro Padovani
Sep 17, 2020·International Journal of Psychiatry in Clinical Practice·Rosa A S Couto, Luís Moreira Gonçalves
Jan 10, 2021·Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology·Shiyu HuLijie Ren
Jun 18, 2021·Current Research in Translational Medicine·Mélanie CatrouxSonia Burrel

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Methods Mentioned

BETA
PCR
sedation

Software Mentioned

Deltamed

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