https://doi.org/10.4081/reumatismo.2023.1598
Anti-N-methyl-d-aspartate receptor encephalitis: mimicker of lupus and multiple sclerosis
Submitted: 27 May 2023
Accepted: 1 October 2023
Published: 19 December 2023
Accepted: 1 October 2023
Abstract Views: 1124
PDF: 298
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Anti-N-methyl-d-aspartate receptor encephalitis (NMDARE) is a B-cell-mediated autoimmune encephalitis with wide non-specific symptoms like acute-onset psychiatric or neurological ones mimicking various other conditions. A careful history and appropriate workup, including cerebrospinal fluid analysis for anti-NMDAR antibodies, imaging, and electroencephalogram, should be conducted, considering all differential diagnoses that can mimic its presentation. Combination therapy with high-dose steroids, plasma exchange, or immunoglobulin therapy has been shown to be more efficacious. In patients who fail first-line therapy, rituximab or cyclophosphamide should be considered. It is essential to rule out ovarian teratoma or other occult malignancies that can cause NMDARE, as removal of the tumor itself resolves this condition. Timely diagnosis and early intervention are necessary to avoid an untoward outcome.
Steeman A, Andriescu I, Sporcq C, Mathieu D, Meurant V, Mazairac G. Case report of anti-NMDA receptor encephalitis in a 24-year-old female: an uncommon presentation. Egypt J Neurol Psychiatr Neurosurg 2022; 58: 79.
DOI: https://doi.org/10.1186/s41983-022-00512-7
Dalmau J, Armangué T, Planagumà J, Radosevic M, Mannara F, Leypoldt F, et al. An update on anti-NMDA receptor encephalitis for neurologists and psychiatrists: mechanisms and models. Lancet Neurol 2019; 18: 1045-57.
DOI: https://doi.org/10.1016/S1474-4422(19)30244-3
Dalmau J, Tüzün E, Wu HY, Masjuan J, Rossi JE, Voloschin A, et al. Paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma. Ann Neurol 2007; 61: 25-36.
DOI: https://doi.org/10.1002/ana.21050
Chiu H, Su Y, Huang S, Chiang H. Anti-NMDAR encephalitis with ovarian teratomas: review of the literature and two case reports. Taiwan J Obstet Gynecol 2019; 58: 313-7.
DOI: https://doi.org/10.1016/j.tjog.2019.03.004
Liu Y, Tian Y, Guo R, Xu X, Zhang M, Li Z, et al. Anti-NMDA receptor encephalitis: retrospective analysis of 15 cases, literature review, and implications for gynecologists. J Healthc Eng 2022; 2022: 4299791.
DOI: https://doi.org/10.1155/2022/4299791
Huang Q, Xie Y, Hu Z, Tang X. Anti-N-methyl-D-aspartate receptor encephalitis: a review of pathogenic mechanisms, treatment, prognosis. Brain Res 2020; 1727: 146549.
DOI: https://doi.org/10.1016/j.brainres.2019.146549
Samanta D, Lui F. Anti-NMDA receptor encephalitis. StatPearls. Treasure Island: StatPearls Publishing, 2022.
DeSena A, Graves D, Warnack W, Greenberg BM. Herpes simplex encephalitis as a potential cause of anti-N-methyl-D- aspartate receptor antibody encephalitis: report of 2 cases. JAMA Neurol 2014; 71: 344-6.
DOI: https://doi.org/10.1001/jamaneurol.2013.4580
Florance NR, Davis RL, Lam C, Szperka C, Zhou L, Ahmad S, et al. Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis in children and adolescents. Ann Neurol 2009; 66: 11-8.
DOI: https://doi.org/10.1002/ana.21756
Delangle R, Demeret S, Canlorbe G, Chelon L, Belghiti J, Gonthier C, et al. Anti-NMDA receptor encephalitis associated with ovarian tumor: the gynecologist point of view. Arch Gynecol Obstet 2020; 302: 315-20.
DOI: https://doi.org/10.1007/s00404-020-05645-9
Lo Sasso B, Agnello L, Bivona G, Bellia C, Ciaccio M. Cerebrospinal fluid analysis in multiple sclerosis diagnosis: an update. Medicina 2019; 55: 245.
DOI: https://doi.org/10.3390/medicina55060245
Bacchi S, Franke K, Wewegama D, Needham E, Patel S, Menon D. Magnetic resonance imaging and positron emission tomography in anti-NMDA receptor encephalitis: a systematic review. J Clin Neurosci 2018; 52: 54-9.
DOI: https://doi.org/10.1016/j.jocn.2018.03.026
Schmitt SE, Pargeon K, Frechette ES, Hirsch LJ, Dalmau J, Friedman D. Extreme delta brush: a unique EEG pattern in adults with anti-NMDA receptor encephalitis. Neurology 2012; 79: 1094-100.
DOI: https://doi.org/10.1212/WNL.0b013e3182698cd8
Wu YY, Feng Y, Huang Y, Zhang JW. Anti-N-methyl-D-aspartate receptor encephalitis in a patient with systemic lupus erythematosus. J Clin Neurol 2016; 12: 502-4.
DOI: https://doi.org/10.3988/jcn.2016.12.4.502
Kelley BP, Corrigan JJ, Patel SC, Griffith BD. Neuropsychiatric lupus with antibody-mediated striatal encephalitis. Am J Neuroradiol 2018; 39: 2263-9.
DOI: https://doi.org/10.3174/ajnr.A5842
Magro-Checa C, Steup-Beekman GM, Huizinga TW, van Buchem MA, Ronen I. Laboratory and neuroimaging biomarkers in neuropsychiatric systemic lupus erythematosus: where do we stand, where to go? Front Med 2018; 5: 340.
DOI: https://doi.org/10.3389/fmed.2018.00340
Zhang S, Yang Y, Long T, Li Z. Systemic lupus erythematosus associated with recurrent anti-NMDA receptor encephalitis during pregnancy. Arch Womens Ment Health 2021; 24: 525-8.
DOI: https://doi.org/10.1007/s00737-020-01088-y
Ogawa E, Nagai T, Sakuma Y, Arinuma Y, Hirohata S. Association of antibodies to the NR1 subunit of N-methyl-D-aspartate receptors with neuropsychiatric systemic lupus erythematosus. Mod Rheumatol 2016; 26: 377-83.
DOI: https://doi.org/10.3109/14397595.2015.1083163
Titulaer MJ, McCracken L, Gabilondo I, Armangué T, Glaser C, Iizuka T, et al. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study. Lancet Neurol 2013; 12: 157-65.
DOI: https://doi.org/10.1016/S1474-4422(12)70310-1
Pham HP, Daniel-Johnson JA, Stotler BA, Stephens H, Schwartz J. Therapeutic plasma exchange for the treatment of anti-NMDA receptor encephalitis. J Clin Apher 2011; 26: 320-5.
DOI: https://doi.org/10.1002/jca.20311
Wang H. Efficacies of treatments for anti-NMDA receptor encephalitis. Front Biosci 2016; 21: 651-63.
DOI: https://doi.org/10.2741/4412
Bartolini L, Muscal E. Differences in treatment of anti-NMDA receptor encephalitis: results of a worldwide survey. J Neurol 2017; 264: 647-53.
DOI: https://doi.org/10.1007/s00415-017-8407-1
Lee WJ, Lee ST, Moon J, Sunwoo JS, Byun JI, Lim JA, et al. Tocilizumab in autoimmune encephalitis refractory to rituximab: an institutional cohort study. Neurotherapeutics 2016; 13: 824-32.
DOI: https://doi.org/10.1007/s13311-016-0442-6
Liba Z, Sebronova V, Komarek V, Sediva A, Sedlacek P. Prevalence and treatment of anti-NMDA receptor encephalitis. Lancet Neurol 2013; 12: 424-5.
DOI: https://doi.org/10.1016/S1474-4422(13)70070-X
Clardy SL. The ExTINGUISH trial of inebilizumab in NMDAR encephalitis (ExTINGUISH); 2022. Available from: https://clinicaltrials.gov/ct2/show/NCT04372615.
Supporting Agencies
NONEHow to Cite
Sanghavi, N., & Ayesha, B. (2023). Anti-N-methyl-d-aspartate receptor encephalitis: mimicker of lupus and multiple sclerosis. Reumatismo, 75(4). https://doi.org/10.4081/reumatismo.2023.1598
Copyright (c) 2023 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
Similar Articles
- Y. Emad, T. Gheita, H. Darweesh, P. Klooster, R. Gamal, H. Fathi, N. El-Shaarawy, M. Gamil, M. Hawass, R.M. El-Refai, H. Al-Hanafi, S. Abd-Ellatif, A. Ismail, J. Rasker, Antibodies to extractable nuclear antigens (ENAS) in systemic lupus erythematosus patients: correlations with clinical manifestations and disease activity , Reumatismo: Vol. 70 No. 2 (2018)
- E. Cipriano, F. Ceccarelli, L. Massaro, F. R. Spinelli, C. Alessandri, C. Perricone, G. Valesini, F. Conti, Joint involvement in patients affected by systemic lupus erythematosus: application of the swollen to tender joint count ratio , Reumatismo: Vol. 67 No. 2 (2015)
- D. Jain, H.K. Aggarwal, V. Kaverappa, S. Dhayia, P. Jain, S. Yadav, Anti-dsDNA negative and anti-Ro positive lupus nephritis: a report of a rare case , Reumatismo: Vol. 65 No. 6 (2013)
- M. A. Marie, R. E. Abu Khalil, H. M. Habib, Urinary CXCL10: a marker of nephritis in lupus patients , Reumatismo: Vol. 65 No. 6 (2013)
- L. Iaccarino, A. Ghirardello, M. Zen, D. Villalta, A. Tincani, L. Punzi, A. Doria, Polarization of TH2 response is decreased during pregnancy in systemic lupus erythematosus , Reumatismo: Vol. 64 No. 5 (2012)
- T. Borges, J. Vilaça, S. Ferreira, I. Chora, S. Silva, C. Dias, Systemic sclerosis sine scleroderma: a case report of anterior uveitis , Reumatismo: Vol. 67 No. 1 (2015)
- E. Chessa, M. Piga, A. Floris, A. Mathieu, A. Cauli, Demyelinating syndrome in SLE: review of different disease subtypes and report of a case series , Reumatismo: Vol. 69 No. 4 (2017)
- H.K. Aggarwal, D. Jain, A. Mittal, A. Rao, R.K. Yadav, P. Jain, Systemic lupus erythematosus presenting as fulminant lupus pneumonitis: a rare case report , Reumatismo: Vol. 68 No. 1 (2016)
- S. Casigliani Rabl, A. Della Rossa, P. Pepe, A. D'Ascanio, M. Mosca, A. Di Vita, S. Bombardieri, Long-term cyclic intravenous iloprost in systemic sclerosis: clinical experience from a single center , Reumatismo: Vol. 64 No. 3 (2012)
- K. Stefanantoni, I. Sciarra, M. Vasile, R. Badagliacca, R. Poscia, M. Pendolino, C. Alessandri, C.D. Vizza, G. Valesini, V. Riccieri, Elevated serum levels of macrophage migration inhibitory factor and stem cell growth factor β in patients with idiopathic and systemic sclerosis associated pulmonary arterial hypertension , Reumatismo: Vol. 66 No. 4 (2014)
You may also start an advanced similarity search for this article.
