title: A case of anti-N-methyl-d-aspartate receptor encephalitis with multiple sclerosis-like demyelinated lesions.
abstract: OBJECTIVE
  To describe an unusual case of a male patient with anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis who presented with multiple white matter lesions. Brain biopsy of the patient was performed, and follow-up evaluation of the cerebrospinal fluid (CSF) NMDAR antibody titer was implemented.
  
  
  METHODS
  Case report.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  A 35-year-old man with anti-NMDAR encephalitis initially presented with fever and psychiatric symptoms. After an initial attack of anti-NMDAR encephalitis, 2 atypical relapses occurred, which presented with myelitis and multifocal white matter lesions; the lesions were open-ring-shaped and partially enhanced.
  
  
  METHODS
  Analysis of the brain biopsy specimen revealed the presence of demyelinated lesions with discrete borders. Subsequent intravenous methylprednisolone therapy resulted in improvement in the brain lesions. Prednisolone and cyclophosphamide were orally administered thereafter. Clinical progression of the disease paralleled observed changes in the CSF NMDAR antibody titer.
  
  
  CONCLUSIONS
  The demyelinated lesions observed in this case were similar to lesions found in multiple sclerosis. On the basis of our finding that the clinical progression of the disease and the associated symptoms paralleled changes in the CSF NMDAR antibody titer, we speculate that the lesions formed as a result of anti-NMDAR encephalitis.
authors: Department of Geriatric Medicine and Neurology, Osaka City University, Graduate School of Medicine, Osaka, Japan. Electronic address: a-taked@med.osaka-cu.ac.jp.
authors: Akitoshi
authors: A
authors: Takeda
authors: Department of Geriatric Medicine and Neurology, Osaka City University, Graduate School of Medicine, Osaka, Japan.
authors: Hiroyuki
authors: H
authors: Shimada
authors: Department of Geriatric Medicine and Neurology, Osaka City University, Graduate School of Medicine, Osaka, Japan.
authors: Akiko
authors: A
authors: Tamura
authors: Department of Geriatric Medicine and Neurology, Osaka City University, Graduate School of Medicine, Osaka, Japan.
authors: Masaaki
authors: M
authors: Yasui
authors: Department of Geriatric Medicine and Neurology, Osaka City University, Graduate School of Medicine, Osaka, Japan.
authors: Kei-Ichi
authors: K
authors: Yamamoto
authors: Department of Geriatric Medicine and Neurology, Osaka City University, Graduate School of Medicine, Osaka, Japan.
authors: Kazuhiro
authors: K
authors: Itoh
authors: Department of Geriatric Medicine and Neurology, Osaka City University, Graduate School of Medicine, Osaka, Japan.
authors: Suzuka
authors: S
authors: Ataka
authors: Department of Diagnostic Pathology, Osaka City University, Graduate School of Medicine, Osaka, Japan.
authors: Sayaka
authors: S
authors: Tanaka
authors: Department of Diagnostic Pathology, Osaka City University, Graduate School of Medicine, Osaka, Japan.
authors: Masahiko
authors: M
authors: Ohsawa
authors: Department of Neuropathology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan.
authors: Hiroyuki
authors: H
authors: Hatsuta
authors: Department of Neurology, Sakai Hospital, Kinki University Faculty of Medicine, Osaka, Japan.
authors: Makito
authors: M
authors: Hirano
authors: Department of Neurology, Sakai Hospital, Kinki University Faculty of Medicine, Osaka, Japan.
authors: Hikaru
authors: H
authors: Sakamoto
authors: Department of Neurology, Sakai Hospital, Kinki University Faculty of Medicine, Osaka, Japan.
authors: Shuichi
authors: S
authors: Ueno
authors: Department of Neurology, Sakai Hospital, Kinki University Faculty of Medicine, Osaka, Japan.
authors: Yusaku
authors: Y
authors: Nakamura
authors: Department of Geriatric Medicine and Neurology, Osaka City University, Graduate School of Medicine, Osaka, Japan.
authors: Tsuyoshi
authors: T
authors: Tsutada
authors: Department of Geriatric Medicine and Neurology, Osaka City University, Graduate School of Medicine, Osaka, Japan.
authors: Takami
authors: T
authors: Miki
keywords: Anti-N-methyl-d-aspartate receptor encephalitis; Brain biopsy; CSF antibody titer; Demyelination; Multiple sclerosis; Neuromyelitis optica