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CASE REPORT
Year : 2021  |  Volume : 7  |  Issue : 1  |  Page : 66-69

Nonparaneoplastic anti-N-methyl-D-aspartate receptor encephalitis with subclinical hyperthyroidism associated with thyroid antibodies


1 Department of Psychiatry, Alluri Sitarama Raju Institute of Medical Sciences, West Godavari, Andhra Pradesh, India
2 Department of Neurology, Alluri Sitarama Raju Institute of Medical Sciences, West Godavari, Andhra Pradesh, India

Correspondence Address:
Dr. Sukeerthi Busi
H. NO: 1-3-204, Suneetha Nilayam, Near Indira Market, Sirpur Kagaznagar, Komaram Bheem - 504 296, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjp.tjp_15_21

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Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an autoimmune disorder with neuropsychiatric symptoms. It is most often misdiagnosed initially as a primary psychiatric disorder. Young women in the background of ovarian teratomas, viral infections are most commonly impacted. Recently, the coexistence of anti-thyroid antibodies with anti-NMDAR antibodies in nonparaneoplastic anti-NMDAR encephalitis has come to light. A 32-year-old married female presented with sudden onset of disruptive and ritualistic behavior, decreased need for sleep, preceded by spikes of high-grade fever, chills, and rigor. Later, she developed episodes of catatonia alternating with spontaneous speech associated with shouting and crying spells. Blood investigations (except for hyperthyroidism and anti-thyroid antibodies), brain imaging, electroencephalogram, and cerebrospinal fluid (CSF) analysis were normal. She was treated with lorazepam (to a maximum of 16 mg), antipsychotics, antidepressants, anticonvulsants, dopaminergic, and steroid drugs with no significant improvement. CSF analysis was repeated for the encephalitis panel and revealed anti-NMDAR encephalitis. The patient was started with intravenous immunoglobulin for 5 days which led to significant clinical improvement. Screening for encephalitis is considered necessary in patients with altered behavior, not responding to symptomatic psychotropic and neurological treatments.


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