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Case report: meningitis as a presenting feature of anti-NMDA receptor encephalitis

Abstract:
BACKGROUND:Meningitis is a very rare atypical presenting feature of anti-NMDA receptor encephalitis. In our case report, we describe an unusual clinical presentation of anti-NMDA receptor encephalitis with a biphasic pattern of meningitis followed by encephalitis and discuss potential mechanisms underlying this presentation. We aim to widen the differential diagnosis to be considered in a patient presenting with clinical meningitis and pyrexia.

CASE PRESENTATION:This is a case of a 33-year old Caucasian woman who initially presented with a lymphocytic meningitis attributed to a viral infection. She subsequently developed fluctuating consciousness, agitation, visual hallucinations, dyskinetic movements, a generalized tonic-clonic seizure, and autonomic instability. Investigations revealed a diagnosis of anti-NMDA receptor encephalitis secondary to a previously unidentified ovarian teratoma. She made an excellent recovery with immunotherapy and removal of the teratoma.

CONCLUSION:Clinicians should consider autoimmune encephalitides in individuals with meningitis, particularly where extensive investigations fail to identify a causative pathogen and there is rapid development of an encephalitic phenotype.
Publication status:
Published
Peer review status:
Peer reviewed

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Publisher copy:
10.1186/s12879-020-4761-1

Authors


More by this author
Institution:
University of Oxford
Division:
MSD
Sub department:
Clinical Neurosciences
Oxford college:
St Hilda's College
Role:
Author



Publisher:
BioMed Central
Journal:
BMC Infectious Diseases More from this journal
Volume:
20
Issue:
1
Article number:
21
Publication date:
2020-01-07
Acceptance date:
2019-12-31
DOI:
EISSN:
1471-2334
ISSN:
1471-2334
Pmid:
31910823

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