Objective: Anti-N-methyl-D-aspartate (anti-NMDA) receptor encephalitis is an autoimmune encephalitis affecting predominantly young females.

Background: It is characterized with neuropsychiatric symptoms, including personality changes, psychosis, autonomic dysfunction, seizures and movement disorders.

Methods: We describe a young woman with anti-NMDA receptor encephalitis who presents with psychotic symptoms and catatonia.

Results: A 19 year-old woman admitted to our outpatient clinic with a history of headache, papilledema for two years, depression for one year and delusions for 2 weeks. Her past medical history revealed ulcerative colitis (UC) and idiopathic intracranial hypertension(IIH). She was on mesalazine and azathiopirine therapy for UC. Acetazolamide and repeated lumbar punction (13 times) had been recommended for IIH in another clinic. Her neurological examination was normal except for apathy, catatonic posture. Her psychiatric examination revealed apathy, insomnia, food refusal and non-systematic paranoid delusions. Brain MRI showed dural thickening and meningeal contrast enhancement especially on frontoparietal cortex. CSF findings identified lymphocytic pleocytosis and CSF protein levels were 187,8 mg/dl. High titers of Anti-NMDA receptor antibodies were present in CSF with a dilution of 1/1000. The proportion of CD19+ B-cells was %6.6. Abdominal ultrasonography and MRI was normal. The patient was diagnosed with tumor negative anti-NMDA receptor encephalitis. She was treated with olanzapine for psychiatric manifestations, intravenous immunoglobulin (IVIG), 0.4 g/kg/d for 5 days and methylprednisolone IV 500 mg/d for 10 days as first line therapy. Because of partial neurological improvement, rituximab 100 mg/ week was administered as the second line therapy.

Conclusions: Anti-NMDAR encephalitis is a treatment responsive encephalitis leading to death and devastating neurological sequelae. The diagnosis is based on clinical suspicion and the detection of antibodies against NMDA receptors in CSF. Early recognition and treatment of anti-NMDAR encephalitis is essential for recovery of neuropsychiatric manifestations of the disease.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/an-extraordinary-cause-of-psychosis-anti-nmda-receptor-encephalitis/