Anti-N-methyl-D-aspartate receptor encephalitis after Herpes simplex virus-associated encephalitis: an emerging disease with diagnosis and therapeutic challenges.
BACKGROUND
Morbidity and mortality of Herpes simplex virus encephalitis (HSE) remain high. Relapses of neurological signs may occur after initial clinical improvement under acyclovir treatment.


METHODS
We report here a case of post-HSE anti-N-methyl-d-aspartate receptor-mediated encephalitis in an adult and perform a systematic search on PubMed to identify other cases in adults.


RESULTS
We identified 11 previously published cases, to discuss diagnostic and therapeutic management. Symptoms in adults are often inappropriate behaviors, confusion and agitation. Diagnosis of anti-NMDA-R encephalitis after HSE is often delayed. Treatment consists in steroids, plasma exchange, and rituximab. Prognosis is often favorable.


CONCLUSIONS
Anti-NMDA-R antibodies should be searched in cerebrospinal fluid of patients with unexpected evolution of HSE. This emerging entity reopens the hot debate about steroids in HSE.
University Hospital of Saint-Etienne, 55 Avenue Albert Raimond, 42055, Saint-Etienne Cedex 2, France.
Flora
F
Schein
University Hospital of Saint-Etienne, 55 Avenue Albert Raimond, 42055, Saint-Etienne Cedex 2, France. amandine.gagneux-brunon@chu-st-etienne.fr.
Amandine
A
Gagneux-Brunon
University Hospital of Saint-Etienne, 55 Avenue Albert Raimond, 42055, Saint-Etienne Cedex 2, France.
Jean-Christophe
JC
Antoine
University Hospital of Saint-Etienne, 55 Avenue Albert Raimond, 42055, Saint-Etienne Cedex 2, France.
Sylvie
S
Lavernhe
University Hospital of Saint-Etienne, 55 Avenue Albert Raimond, 42055, Saint-Etienne Cedex 2, France.
Sylvie
S
Pillet
University Hospital of Saint-Etienne, 55 Avenue Albert Raimond, 42055, Saint-Etienne Cedex 2, France.
Stéphane
S
Paul
University Hospital of Saint-Etienne, 55 Avenue Albert Raimond, 42055, Saint-Etienne Cedex 2, France.
Anne
A
Frésard
University Hospital of Saint-Etienne, 55 Avenue Albert Raimond, 42055, Saint-Etienne Cedex 2, France.
Claire
C
Boutet
University Hospital of Saint-Etienne, 55 Avenue Albert Raimond, 42055, Saint-Etienne Cedex 2, France.
Rémi
R
Grange
University Hospital of Saint-Etienne, 55 Avenue Albert Raimond, 42055, Saint-Etienne Cedex 2, France.
Céline
C
Cazorla
University Hospital of Saint-Etienne, 55 Avenue Albert Raimond, 42055, Saint-Etienne Cedex 2, France.
Frédéric
F
Lucht
University Hospital of Saint-Etienne, 55 Avenue Albert Raimond, 42055, Saint-Etienne Cedex 2, France.
Elisabeth
E
Botelho-Nevers
D000212:Acyclovir / Q000627:therapeutic use*; D060426:Anti-N-Methyl-D-Aspartate Receptor Encephalitis / Q000175:diagnosis* / Q000188:drug therapy / Q000628:therapy*; D000998:Antiviral Agents / Q000627:therapeutic use*; D021821:Communicable Diseases, Emerging / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy; D020803:Encephalitis, Herpes Simplex / Q000175:diagnosis* / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D005602:France; D006801:Humans; D008875:Middle Aged; D012008:Recurrence
D000998:Antiviral Agents; D000212:Acyclovir
Anti-NMDA-receptor antibodies; Autoimmune encephalitis; Encephalitis; Herpes simplex virus; Neurological relapses