Anti-N-Methyl-D-Aspartate Receptor Encephalitis with Concomitant Detection of Epstein-Barr Virus

Abstract

Introduction: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an important cause of encephalitis worldwide. While some cases are associated with neoplasms, in the remaining cases the etiology is unclear. Recent literature suggests that viral brain infections, mainly of the herpesviridae family, may be associated and/or trigger NMDAR encephalitis. Case Report: A 34-year-old woman with a 1-month-long history of progressive behavioral and language deterioration came to emergency department after a first unprovoked seizure followed by a focal status epilepticus. Brain computerized tomography was normal, but electroencephalography showed epileptiform activity over the left fronto-temporal region. She was admitted to the intensive care unit. Brain magnetic resonance imaging showed subtle T2 hypersignal in the parietal, fronto-opercular and insular regions. Cerebrospinal fluid (CSF) was positive for Epstein Barr virus (EBV) DNA whilst anti-NMDA antibodies were identified both in the CSF and blood. No tumors were detected after thorough investigation. Following intravenous steroids, plasma exchange and rituximab treatment she slowly improved being discharged home and at a 3-month follow-up she was sequels free. Conclusion: Despite the clear association between herpes virus simplex and NMDAR encephalitis, no such unequivocal relation has been reported for other virus, namely EBV. We report a case of NMDAR encephalitis which might be associated and triggered by EBV infection, identified by polymerase chain reaction.