Open Access Highly Accessed Case report

Anti-N-methyl-D-aspartate receptor encephalitis presenting with acute psychosis in a preteenage girl: a case report

Paraskevi Maggina1*, Mersini Mavrikou1, Stavroula Karagianni2, Chrysanthi L Skevaki3, Antigoni Triantafyllidou1, Constantinos Voudris4, Eustathia Katsarou4, Lela Stamogiannou1 and Sotiria Mastroyianni4

Author Affiliations

1 1st Department of Pediatrics, "P & A Kyriakou" Children’s Hospital, Athens, Greece

2 Department of Pedopsychiatric Care, "P & A Kyriakou" Children’s Hospital, Athens, Greece

3 Research Laboratories, "P & A Kyriakou" Children's Hospital, Athens, Greece

4 Department of Neurology, "P & A Kyriakou" Children’s Hospital, Athens, Greece

For all author emails, please log on.

Journal of Medical Case Reports 2012, 6:224  doi:10.1186/1752-1947-6-224

Published: 30 July 2012

Abstract

Introduction

Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a rare, newly defined autoimmune clinical entity that presents with atypical clinical manifestations. Most patients with anti-N-methyl-D-aspartate receptor encephalitis develop a progressive illness from psychosis into a state of unresponsiveness, with catatonic features often associated with abnormal movements and autonomic instability. This is the first report of anti-N-methyl-D-aspartate receptor encephalitis in a Greek pediatric hospital.

Case presentation

An 11-year-old Greek girl presented with clinical manifestations of acute psychosis. The differential diagnosis included viral encephalitis. The presence of a tumor usually an ovarian teratoma, a common clinical finding in many patients, was excluded. Early diagnosis and prompt immunotherapy resulted in full recovery up to one year after the initial diagnosis.

Conclusion

Acute psychosis is a rare psychiatric presentation in children, diagnosed only after possible organic syndromes that mimic acute psychosis are excluded, including anti-N-methyl-D-aspartate receptor receptor encephalitis. Pediatricians, neurologists and psychiatrists should consider this rare clinical syndrome, in order to make an early diagnosis and instigate appropriate treatment to maximize neurological recovery.

Keywords:
NMDAR; Encephalitis; Psychosis; Children