Anti-N-methyl-D-aspartate receptor encephalitis after Herpes simplex virus-associated encephalitis: an emerging disease with diagnosis and therapeutic challenges

Infection. 2017 Aug;45(4):545-549. doi: 10.1007/s15010-016-0959-y. Epub 2016 Nov 8.

Abstract

Introduction: Morbidity and mortality of Herpes simplex virus encephalitis (HSE) remain high. Relapses of neurological signs may occur after initial clinical improvement under acyclovir treatment.

Methods: We report here a case of post-HSE anti-N-methyl-d-aspartate receptor-mediated encephalitis in an adult and perform a systematic search on PubMed to identify other cases in adults.

Results: We identified 11 previously published cases, to discuss diagnostic and therapeutic management. Symptoms in adults are often inappropriate behaviors, confusion and agitation. Diagnosis of anti-NMDA-R encephalitis after HSE is often delayed. Treatment consists in steroids, plasma exchange, and rituximab. Prognosis is often favorable.

Conclusion: Anti-NMDA-R antibodies should be searched in cerebrospinal fluid of patients with unexpected evolution of HSE. This emerging entity reopens the hot debate about steroids in HSE.

Keywords: Anti-NMDA-receptor antibodies; Autoimmune encephalitis; Encephalitis; Herpes simplex virus; Neurological relapses.

Publication types

  • Case Reports

MeSH terms

  • Acyclovir / therapeutic use*
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis / diagnosis*
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis / drug therapy
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis / therapy*
  • Antiviral Agents / therapeutic use*
  • Communicable Diseases, Emerging / diagnosis
  • Communicable Diseases, Emerging / drug therapy
  • Communicable Diseases, Emerging / therapy
  • Encephalitis, Herpes Simplex / diagnosis*
  • Encephalitis, Herpes Simplex / drug therapy
  • Encephalitis, Herpes Simplex / therapy*
  • Female
  • France
  • Humans
  • Middle Aged
  • Recurrence

Substances

  • Antiviral Agents
  • Acyclovir