Case report: Anti-NMDA receptor encephalitis manifesting as rapid weight loss and abnormal movement disorders with alternating unilateral ptosis and contralateral limb tremor

Autoimmune-related movement disorders

Movement disorders (MDs) are common symptoms of autoimmune diseases. However, the clinical spectrum of MDs in autoimmune diseases remains poorly characterized, largely due to the scarcity of large-scale clinical surveys and trials. Most available data are derived from case reports and small case series. Here, we review the 123 currently reported cases of patients with autoimmune-related MDs and evaluate the demographic and clinical characteristics, pathophysiologies, and treatments. Autoimmune MDs were observed in various diseases involving autoimmune processes, including autoimmune encephalitis (AE), central nervous system infections, and systemic autoimmune diseases; even some typical autoimmune diseases of the peripheral nervous system may also cause MDs. Owing to the diversity of aetiologies and pathophysiologies of these diseases, the clinical characteristics and prognoses of these autoimmune-related MDs are highly variable. The mechanisms underlying MDs in autoimmune diseases involve abnormalities in neuronal signalling pathways, including neurotransmitter and receptor dysfunction, as well as direct antibody-mediated attacks on neuronal structures.

Late relapse of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis: a case report

BACKGROUND

Anti-N-methyl-D-aspartate receptor encephalitis is a sporadic autoimmune disorder of the brain that presents in a variety of neuropsychiatric manifestations, including seizures, psychosis, and alterations in behavior. N-methyl-D-aspartate receptor is primarily seen in young females. Although this disease can be treated, it can relapse in rare cases. Relapsing typically occurs within the early years following the initial episode and is exceedingly rare after 5 years.

CASE PRESENTATION

In this case study, we report on a 16-year-old Iranian female experiencing a relapse of anti-N-methyl-D-aspartate receptor encephalitis 8 years after her initial diagnosis. She was admitted to the hospital with dysphasia (a speech disorder) and dyslexia (reading and writing impairment). A thorough clinical evaluation revealed the presence of anti-glutamate receptor type N-methyl-D-aspartate receptor antibodies in her serum and cerebrospinal fluid, confirming the diagnosis. Following treatment with immunotherapy and plasmapheresis, she made a complete recovery.

CONCLUSION

This case of relapsing anti-N-methyl-D-aspartate receptor encephalitis, occurring more than 5 years after the initial episode, is exceptionally rare. This late relapse underscores the importance of long-term follow-up for patients with this condition.