Anti-NMDAR encephalitis presenting after immature teratoma resection

This is a case of a young woman who developed neurological and psychiatric symptoms 3 days after resection of an immature teratoma. She was diagnosed with anti-NMDA receptor encephalitis via positive serum antibody titres, which was later confirmed with cerebrospinal fluid antibody titres. Given her cancer diagnosis, she underwent treatment with bleomycin, etoposide and cisplatin chemotherapy in addition to 5 days of high-dose steroids (1 g of intravenous methylprednisolone) for the encephalitis. This treatment regimen led to significant clinical improvement 3 weeks after completion of one cycle of chemotherapy.

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Persistent seropositivity in oophorectomy-resistant anti-NMDA receptor encephalitis

BMJ Case Reports ◽

10.1136/bcr-2021-241878 ◽

2021 ◽

Vol 14 (9) ◽

pp. e241878

Author(s):

Susmit Tripathi ◽

Nara M Michaelson ◽

Alan Segal

Keyword(s):

Clinical Decision Making ◽

Serum Antibody ◽

Disease Patient ◽

Clinical Decision ◽

High Serum ◽

Nmda Receptor Encephalitis ◽

Resistant Disease ◽

Nmdar Encephalitis ◽

Antibody Titres ◽

Case Basis

To discuss (1) the significance of seropositivity in anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis and (2) clinical decision making in oophorectomy resistant disease. Patient A (a 35-year-old woman) had high CSF and serum anti-NMDA antibody titres, a complicated hospital course, little improvement with first and second-line therapies, and remained with high CSF and serum antibody titres despite unilateral oophorectomy, requiring a nearly 13-month long hospitalisation. Conversely, patient B (a 29-year-old woman) had low CSF titres, seronegative disease and quickly recovered to her baseline with first line therapies and oophorectomy. Anti-NMDAR antibodies are themselves pathological, causing signalling dysfunction and internalisation of the NMDAR. Seropositivity with anti-NMDAR antibodies likely reflects leakage from the blood–brain barrier, with high serum titres being a downstream effect of high CSF titres. Empiric bilateral oophorectomies is controversial but appropriate on a case-by-case basis in extremely treatment-resistant NMDAR encephalitis given the possibility of antigenic microteratomas, which may not be detected on imaging or even bilateral ovarian biopsies.

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Molecular mimicry of NMDA receptors may contribute to neuropsychiatric symptoms in severe COVID-19 cases

Journal of Neuroinflammation ◽

10.1186/s12974-021-02293-x ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Veronika Vasilevska ◽

Paul C. Guest ◽

Hans-Gert Bernstein ◽

Matthias L. Schroeter ◽

Christian Geis ◽

...

Keyword(s):

Nmda Receptor ◽

Molecular Mimicry ◽

Psychiatric Symptoms ◽

Auditory Hallucination ◽

Neuropsychiatric Symptoms ◽

Autoimmune Encephalitis ◽

Altered Mental Status ◽

Warning Signs ◽

High Dose ◽

Nmda Receptor Encephalitis

AbstractApproximately 30% of individuals with severe SARS-CoV-2 infections also develop neurological and psychiatric complaints. In rare cases, the occurrence of autoimmune encephalitis has been reported after SARS-CoV-2 infection. In this systematic review, we have identified eight SARS-CoV-2-associated cases of anti-NMDA receptor encephalitis. All had cerebrospinal fluid antibodies against the NMDA receptor and a recent onset of working memory deficits, altered mental status, or psychiatric symptoms, such as confusion, agitation, auditory hallucination, catatonia and speech dysfunction. All patients received high-dose steroid and immunoglobulin therapeutics and conditions improved in each case. These findings suggest that clinical attention should be paid to warning signs of autoimmune encephalitis in severe COVID-19 cases. If characteristic features of autoimmune encephalitis are present, autoantibody diagnostics should be performed and confirmed cases should be treated with immunotherapy to minimize neurological impairments.

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Encephalitozoon cuniculi causes focal anterior cataract and uveitis in dogs

Tierärztliche Praxis Ausgabe K Kleintiere / Heimtiere ◽

10.15654/tpk-141053 ◽

2015 ◽

Vol 43 (05) ◽

pp. 337-344 ◽

Cited By ~ 6

Author(s):

J. Csokai ◽

A. Fuchs-Baumgartinger ◽

G. Maaß ◽

B. Nell

Keyword(s):

Serum Antibody ◽

Encephalitozoon Cuniculi ◽

Anterior Lens Capsule ◽

Positive Serum ◽

Posterior Synechia ◽

Antibody Titres ◽

Inflammatory Drugs ◽

Anti Inflammatory ◽

Lens Material

SummaryThree mongrel dogs, aged 10 months (case 1), 14 months (case 2) and 7.5 years (case 3), were presented because of ophthalmologic disorders of 4 months, 6 months and 7 years duration, respectively. All three dogs were offspring of stray dogs from Hungary and Serbia and had positive serum antibody titres against Encephalitozoon (E.) cuniculi. The two young dogs showed unilateral, the older dog bilateral chronic anterior uveitis with posterior synechia and focal anterior cortical cataract. The fundi that could be evaluated developed focal tapetal hyporeflective lesions in the course of the disease. Dogs 1 and 2 underwent removal of the lens via phacoemulsification. PCR of the lens material was positive for E. cuniculi strains IV and II, respectively. In dog 2 findings suggestive of microsporidia were detected underneath the anterior lens capsule by immunohistochemical staining. In all cases medical treatment consisted of systemic fenbendazole, prednisolone, and topical anti-inflammatory drugs, and additional brinzolamid/timolol for dog 3. For the time being all cases (follow up 23 months, 6 months and 3 months, respectively) are still on topical anti-inflammatory therapy. It is concluded that E. cuniculi infections can cause cataract and chorioretinal lesions in dogs.

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Virus-specific memory T cell responses unmasked by immune checkpoint blockade cause hepatitis

Nature Communications ◽

10.1038/s41467-021-21572-y ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

James A. Hutchinson ◽

Katharina Kronenberg ◽

Paloma Riquelme ◽

Jürgen J. Wenzel ◽

Gunther Glehr ◽

...

Keyword(s):

Immune Checkpoint ◽

Serum Antibody ◽

Immune Checkpoint Blockade ◽

Checkpoint Blockade ◽

Effector Memory ◽

Specific Memory ◽

Immune Mediated ◽

Antibody Titres ◽

Pre Treatment ◽

After Cancer

AbstractTreatment of advanced melanoma with combined PD-1/CTLA-4 blockade commonly causes serious immune-mediated complications. Here, we identify a subset of patients predisposed to immune checkpoint blockade-related hepatitis who are distinguished by chronic expansion of effector memory CD4+ T cells (TEM cells). Pre-therapy CD4+ TEM cell expansion occurs primarily during autumn or winter in patients with metastatic disease and high cytomegalovirus (CMV)-specific serum antibody titres. These clinical features implicate metastasis-dependent, compartmentalised CMV reactivation as the cause of CD4+ TEM expansion. Pre-therapy CD4+ TEM expansion predicts hepatitis in CMV-seropositive patients, opening possibilities for avoidance or prevention. 3 of 4 patients with pre-treatment CD4+ TEM expansion who received αPD-1 monotherapy instead of αPD-1/αCTLA-4 therapy remained hepatitis-free. 4 of 4 patients with baseline CD4+ TEM expansion given prophylactic valganciclovir and αPD-1/αCTLA-4 therapy remained hepatitis-free. Our findings exemplify how pathogen exposure can shape clinical reactions after cancer therapy and how this insight leads to therapeutic innovations.

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Risk factors for equine influenza serum antibody titres in young Thoroughbred racehorses given an inactivated vaccine

Preventive Veterinary Medicine ◽

10.1016/s0167-5877(00)00144-6 ◽

2000 ◽

Vol 46 (2) ◽

pp. 129-141 ◽

Cited By ~ 24

Author(s):

J.R Newton ◽

K.H Lakhani ◽

J.L.N Wood ◽

D.J Baker

Keyword(s):

Risk Factors ◽

Serum Antibody ◽

Inactivated Vaccine ◽

Equine Influenza ◽

Thoroughbred Racehorses ◽

Antibody Titres

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High-dose intravenous methylprednisolone in the treatment of multiple sclerosis: Clinical-immunologic correlations

Neurology ◽

10.1212/wnl.36.2.238 ◽

1986 ◽

Vol 36 (2) ◽

pp. 238-238 ◽

Cited By ~ 122

Author(s):

L. Durelli ◽

D. Cocito ◽

A. Riccio ◽

C. Barile ◽

B. Bergamasco ◽

...

Keyword(s):

Multiple Sclerosis ◽

High Dose ◽

Intravenous Methylprednisolone

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Frequency and temporal sequence of clinical features in adults with anti-NMDA receptor encephalitis presenting with psychiatric symptoms

Psychological Medicine ◽

10.1017/s0033291718003665 ◽

2018 ◽

Vol 49 (16) ◽

pp. 2709-2716 ◽

Cited By ~ 3

Author(s):

Ronald J. Gurrera

Keyword(s):

Nmda Receptor ◽

Clinical Features ◽

Psychiatric Symptoms ◽

Autoimmune Encephalitis ◽

Signs And Symptoms ◽

Nmda Receptor Encephalitis ◽

Nmdar Encephalitis ◽

Unexplained Fever ◽

Study Inclusion

AbstractBackgroundAnti-NMDA receptor (NMDAr) encephalitis is the most common autoimmune encephalitis in adults. It mimics psychiatric disorders so often that most patients are initially referred to a psychiatrist, and many are misdiagnosed. Without prompt and effective treatment, patients are likely to suffer a protracted course with significant residual disability, or death. This study focuses on the frequency and chronology of salient clinical features in adults with anti-NMDAr encephalitis who are likely to be first evaluated by a psychiatrist because their presentation suggests a primary psychiatric disorder.MethodsA systematic search of PubMed and EMBASE databases identified published reports of anti-NMDAr encephalitis associated with prominent behavioral or psychiatric symptoms. After eliminating redundancies, the frequencies and relative timing of clinical features were tabulated. Signs and symptoms were assigned temporal ranks based on the timing of their first appearance relative to the first appearance of other signs and symptoms in each patient; median ranks were used to compare temporal sequencing of both individual features and major symptom domains.ResultsTwo hundred thirty unique cases (185 female) met study inclusion criteria. The most common features were seizures (60.4%), disorientation/confusion (42.6%), orofacial dyskinesias (39.1%), and mutism/staring (37.4%). Seizures, fever, and cognitive dysfunction were often the earliest features to emerge, but psychiatric features predominated and sequencing varied greatly between individuals.ConclusionsClinicians should consider anti-NMDAr encephalitis when new psychiatric symptoms are accompanied by a recent viral prodrome, seizures or unexplained fever, or when the quality of the psychiatric symptoms is unusual (e.g. non-verbal auditory hallucinations).

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