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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.

Original publication

DOI

10.1186/s12879-020-4761-1

Type

Journal article

Journal

BMC Infect Dis

Publication Date

07/01/2020

Volume

20

Keywords

Anti-NMDA receptor, Anti-NMDAR, Encephalitis, Meningitis, Administration, Intravenous, Adult, Anti-N-Methyl-D-Aspartate Receptor Encephalitis, Antibodies, Diagnosis, Differential, Encephalitis, Female, Fever, Glucocorticoids, Hashimoto Disease, Humans, Immunotherapy, Meningitis, Viral, Methylprednisolone, Ovarian Neoplasms, Plasma Exchange, Receptors, N-Methyl-D-Aspartate, Seizures, Teratoma, Treatment Outcome