Case report: severe adolescent major depressive syndrome turns out to be an unusual case of anti-NMDA receptor encephalitis
Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a neuroinflammatory condition mediated by autoantibodies against the GluN1 subunit of the receptor. Clinically, it is characterized by a complex neuropsychiatric presentation with rapidly progressive psychiatric symptoms, cognitive deficits,...
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| Main Authors: | , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
25 May 2021
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| In: |
Frontiers in psychiatry
Year: 2021, Volume: 12, Pages: 1-6 |
| ISSN: | 1664-0640 |
| DOI: | 10.3389/fpsyt.2021.679996 |
| Online Access: | Verlag, kostenfrei, Volltext: https://doi.org/10.3389/fpsyt.2021.679996 Verlag, kostenfrei, Volltext: https://www.frontiersin.org/articles/10.3389/fpsyt.2021.679996/full 
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| Author Notes: | Alexander Moldavski, Holger Wenz, Bettina E. Lange, Cathrin Rohleder and F. Markus Leweke |
| Summary: | Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a neuroinflammatory condition mediated by autoantibodies against the GluN1 subunit of the receptor. Clinically, it is characterized by a complex neuropsychiatric presentation with rapidly progressive psychiatric symptoms, cognitive deficits, seizures, and abnormal movements. Isolated psychiatric manifestations of anti-NMDAR encephalitis are rare and usually dominated by psychotic symptoms. We present a case of an 18-year-old female high school student - without a previous history of psychiatric disorders - with a rapid onset severe depressive syndrome. Surprisingly, we found pleocytosis and anti-NMDAR autoantibodies in the cerebrospinal fluid (CSF), despite an otherwise unremarkable diagnostic workup, including blood test, clinical examination, and cranial magnetic resonance imaging (MRI). After intravenous immunoglobulins treatment, a complete remission of the initial symptoms was observed. In a follow-up five years later, the young woman did not experience any relapse or sequelae. Anti-NMDAR encephalitis can present in rare cases as an organic disorder with major depressive symptoms without distinct concomitant psychotic or neurological symptoms. A clinical presentation such as a rapid onset of symptoms, distinct disturbance in the thought process, restlessness, and cognitive deficits should prompt screening for NMDAR- and other neural autoantibodies to rule out this rare but debilitating pathology. |
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| Item Description: | Gesehen am 23.09.2021 |
| Physical Description: | Online Resource |
| ISSN: | 1664-0640 |
| DOI: | 10.3389/fpsyt.2021.679996 |