HSV encephalitis-induced anti-NMDAR encephalitis in a 67-year-old woman: report of a case and review of the literature

Nicholas A Morris; Tamara B Kaplan; Jenny Linnoila; Tracey Cho

doi:10.1007/s13365-015-0364-9

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HSV encephalitis-induced anti-NMDAR encephalitis in a 67-year-old woman: report of a case and review of the literature

Journal article

Peer reviewed

HSV encephalitis-induced anti-NMDAR encephalitis in a 67-year-old woman: report of a case and review of the literature

Nicholas A Morris, Tamara B Kaplan, Jenny Linnoila and Tracey Cho

Journal of neurovirology, Vol.22(1), pp.33-37

02/2016

DOI: 10.1007/s13365-015-0364-9

PMID: 26139017

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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.

Acyclovir - therapeutic use

Humans

Immunosuppressive Agents - therapeutic use

Simplexvirus - pathogenicity

Encephalitis, Herpes Simplex - complications

DNA-Directed DNA Polymerase - genetics

Rituximab - therapeutic use

DNA-Directed DNA Polymerase - cerebrospinal fluid

Simplexvirus - growth & development

Female

Anti-N-Methyl-D-Aspartate Receptor Encephalitis - drug therapy

Gene Expression

Anti-N-Methyl-D-Aspartate Receptor Encephalitis - etiology

Antiviral Agents - therapeutic use

Simplexvirus - genetics

Anti-N-Methyl-D-Aspartate Receptor Encephalitis - pathology

Viral Proteins - genetics

Anti-N-Methyl-D-Aspartate Receptor Encephalitis - virology

Encephalitis, Herpes Simplex - pathology

Autoantibodies - cerebrospinal fluid

Encephalitis, Herpes Simplex - virology

Immunoglobulins, Intravenous - therapeutic use

Encephalitis, Herpes Simplex - drug therapy

Aged

Viral Proteins - cerebrospinal fluid

Details

Title: Subtitle: HSV encephalitis-induced anti-NMDAR encephalitis in a 67-year-old woman: report of a case and review of the literature
Creators: Nicholas A Morris - Department of Neurology, Columbia University Medical Center, New York, 10032, NY, USA. nam2185@cumc.columbia.edu
Tamara B Kaplan - Department of Neurology, Massachusetts General Hospital, Boston, MA, 02114, USA. tbkaplan@partners.org
Jenny Linnoila - Department of Neurology, Massachusetts General Hospital, Boston, MA, 02114, USA. jlinnoila@partners.org
Tracey Cho - Department of Neurology, Massachusetts General Hospital, Boston, MA, 02114, USA. tcho@partners.org
Resource Type: Journal article
Publication Details: Journal of neurovirology, Vol.22(1), pp.33-37
Publisher: United States
DOI: 10.1007/s13365-015-0364-9
PMID: 26139017
ISSN: 1355-0284
eISSN: 1538-2443
Language: English
Date published: 02/2016
Academic Unit: Neurology; Iowa Neuroscience Institute
Record Identifier: 9984070145402771

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