title: HSV encephalitis-induced anti-NMDAR encephalitis in a 67-year-old woman: report of a case and review of the literature.
abstract: Herpes simplex virus (HSV) encephalitis can induce an autoimmune encephalitis mediated by autoantibodies against the N-methyl-D-aspartate receptor (NMDAR). Post-HSV NMDAR encephalitis and de novo NMDAR encephalitis have been more commonly described in children and young adults. We describe the case of a 67-year-old woman with post-HSV NMDAR encephalitis and review the relevant literature. Clinical, serological, neurophysiological, and imaging evaluations were undertaken in the evaluation of this patient. A literature review was performed. Nearly 2 months after a typical course of HSV encephalitis confirmed by HSV polymerase chain reaction studies from the spinal fluid and treated with intravenous acyclovir, a 67-year-old woman suffered neurological deterioration. There was no evidence of active HSV infection, but NMDAR antibodies were found in her serum and spinal fluid. The patient improved after initiation of immunosuppressive therapy. All patients who experience new or recurrent neurological symptoms following recovery from HSV encephalitis should be evaluated for post-infectious autoimmune encephalitis, including NMDAR encephalitis.
authors.affiliation: Department of Neurology, Columbia University Medical Center, New York, 10032, NY, USA. nam2185@cumc.columbia.edu.
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Morris
authors.affiliation: Department of Neurology, Brigham & Women's Hospital, Boston, MA, 02114, USA. tbkaplan@partners.org.|Department of Neurology, Massachusetts General Hospital, Boston, MA, 02114, USA. tbkaplan@partners.org.
authors.forename: Tamara B
authors.initials: TB
authors.lastname: Kaplan
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA, 02114, USA. jlinnoila@partners.org.
authors.forename: Jenny
authors.initials: J
authors.lastname: Linnoila
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA, 02114, USA. tcho@partners.org.
authors.forename: Tracey
authors.initials: T
authors.lastname: Cho
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000368:Aged; D060426:Anti-N-Methyl-D-Aspartate Receptor Encephalitis / Q000188:drug therapy / Q000209:etiology / Q000473:pathology / Q000821:virology*; D000998:Antiviral Agents / Q000627:therapeutic use*; D001323:Autoantibodies / Q000134:cerebrospinal fluid; D004259:DNA-Directed DNA Polymerase / Q000134:cerebrospinal fluid / Q000235:genetics; D020803:Encephalitis, Herpes Simplex / Q000150:complications / Q000188:drug therapy / Q000473:pathology / Q000821:virology*; D005260:Female; D015870:Gene Expression; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D000069283:Rituximab / Q000627:therapeutic use; D018139:Simplexvirus / Q000235:genetics / Q000254:growth & development / Q000472:pathogenicity; D014764:Viral Proteins / Q000134:cerebrospinal fluid / Q000235:genetics
chemical_list: D000998:Antiviral Agents; D001323:Autoantibodies; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D014764:Viral Proteins; D000069283:Rituximab; D004259:DNA-Directed DNA Polymerase; D000212:Acyclovir
keywords: All neuropsychology/behavior; Autoimmune diseases; Encephalitis; Post-infectious; Viral infections