title: Anti-N-methyl-D-aspartate receptor encephalitis with serum anti-thyroid antibodies and IgM antibodies against Epstein-Barr virus viral capsid antigen: a case report and one year follow-up.
abstract: BACKGROUND
  Anti-N-methyl-D-aspartate receptor encephalitis is an increasingly common autoimmune disorder mediated by antibodies to certain subunit of the N-methyl-D-aspartate receptor. Recent literatures have described anti-thyroid and infectious serology in this encephalitis but without follow-up.
  
  
  METHODS
  A 17-year-old Chinese female patient presented with psychiatric symptoms, memory deficits, behavioral problems and seizures. She then progressed through unresponsiveness, dyskinesias, autonomic instability and central hypoventilation during treatment. Her conventional blood work on admission showed high titers of IgG antibodies to thyroglobulin, thyroid peroxidase and IgM antibodies to Epstein-Barr virus viral capsid antigen. An immature ovarian teratoma was found and removal of the tumor resulted in a full recovery. The final diagnosis of anti-N-methyl-D-aspartate receptor encephalitis was made by the identification of anti-N-methyl-D-aspartate receptor antibodies in her cerebral spinal fluid. Pathology studies of the teratoma revealed N-methyl-D-aspartate receptor subunit 1 positive ectopic immature nervous tissue and Epstein-Barr virus latent infection. She was discharged with symptoms free, but titers of anti-thyroid peroxidase and anti-thyroglobulin antibodies remained elevated. One year after discharge, her serum remained positive for anti-thyroid peroxidase and anti-N-methyl-D-aspartate receptor antibodies, but negative for anti-thyroglobulin antibodies and IgM against Epstein-Barr virus viral capsid antigen.
  
  
  CONCLUSIONS
  Persistent high titers of anti-thyroid peroxidase antibodies from admission to discharge and until one year later in this patient may suggest a propensity to autoimmunity in anti- N-methyl-D-aspartate receptor encephalitis and support the idea that neuronal and thyroid autoimmunities represent a pathogenic spectrum. Enduring anti-N-methyl-D-aspartate receptor antibodies from admission to one year follow-up but seroreversion of Epstein-Barr virus viral capsid antigen IgM may raise the important issue of elucidating the triggers and boosters of anti- N-methyl-D-aspartate receptor encephalitis.
authors: Department of Neurology, Beijing Friendship Hospital, Capital Medical University, No,95 Yong'An Road, Beijing, 100050, China. xchling@yahoo.cn
authors: Chun-Ling
authors: CL
authors: Xu
authors: Lei
authors: L
authors: Liu
authors: Wei-Qin
authors: WQ
authors: Zhao
authors: Ji-Mei
authors: JM
authors: Li
authors: Rui-Jin
authors: RJ
authors: Wang
authors: Shu-Hui
authors: SH
authors: Wang
authors: De-Xin
authors: DX
authors: Wang
authors: Mei-Yun
authors: MY
authors: Liu
authors: Shan-Shan
authors: SS
authors: Qiao
authors: Jia-Wei
authors: JW
authors: Wang
mesh_terms: D000956:Antigens, Viral / Q000276:immunology; D001323:Autoantibodies / Q000097:blood / Q000276:immunology; D001324:Autoantigens / Q000276:immunology; D001327:Autoimmune Diseases / Q000276:immunology / Q000821:virology*; D036022:Capsid Proteins / Q000276:immunology; D004660:Encephalitis / Q000150:complications / Q000276:immunology / Q000821:virology*; D020031:Epstein-Barr Virus Infections / Q000097:blood / Q000150:complications / Q000276:immunology; D005260:Female; D005455:Fluorescent Antibody Technique; D005500:Follow-Up Studies; D004854:Herpesvirus 4, Human / Q000276:immunology; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood / Q000276:immunology; D007075:Immunoglobulin M / Q000097:blood / Q000276:immunology; D007453:Iodide Peroxidase / Q000276:immunology; D010051:Ovarian Neoplasms / Q000150:complications* / Q000276:immunology / Q000821:virology; D011863:Radioimmunoassay; D016194:Receptors, N-Methyl-D-Aspartate / Q000276:immunology*; D013724:Teratoma / Q000150:complications* / Q000276:immunology / Q000821:virology; D013954:Thyroglobulin / Q000276:immunology; D055815:Young Adult
chemical_list: D000956:Antigens, Viral; D001323:Autoantibodies; D001324:Autoantigens; D036022:Capsid Proteins; C041788:Epstein-Barr viral capsid antigen; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D016194:Receptors, N-Methyl-D-Aspartate; D013954:Thyroglobulin; D007453:Iodide Peroxidase