Increasing Awareness in the Diagnosis and Treatment of NMDA Encephalitis (P05.212)

Objective: To report the definitive diagnosis of anti-NMDA receptor (NMDAR) encephalitis in a 19-year old male with no known malignancy. Background Anti-NMDA receptor (NMDAR) encephalitis is a rare form of autoimmune disease mostly affecting young women with known ovarian malignancy. In this case report, we present a case of a 19 year old male with NMDAR encephalitis with no known malignancy. Although the clinical features of the acute disease are well characterized, the search for malignancy in this young male yielded negative results. Design/Methods: This is a case report where extensive review of history and laboratory evaluation including testing for NMDAR in serum and CSF was determined. Results: This is a case of a 19 year old male who initially presented with generalized tonic-clonic seizure with no evidence of epileptiform discharge on his EEG. His neurologic status has deteriorated and eventually presented with bizarre symptoms including alternating tachycardia and bradycardia, asystole, orofacial dyskinesias, hypoventilation and episodes of apnea. Initial tests were unrevealing, including a brain MRI, nonspecific CSF pleocytosis with lymphocytic predominance with negative bacterial, viral and fungal studies in the CSF. Work-up for malignancy has yielded negative results. Patient9s CSF was found positive for NMDA antibody. Conclusions: Although NMDAR encephalitis usually present in females with known ovarian teratoma. Our patient9s clinical presentation emphasizes that anti-NMDAR encephalitis can present in males with no known malignancy. When diagnosed early on, it is potentially reversible with immuno-modulatory treatment and often have good prognosis. Disclosure: Dr. Valenzuela has nothing to disclose. Dr. Zallek has nothing to disclose. Dr. Nersesyan has nothing to disclose. Dr. Kattah has received personal compensation for activities with Biogen Idec as a consultant. Dr. Kattah has received personal compensation in an editorial capacity for Bayer Pharmaceuticals Corporation. Dr. Blume has nothing to disclose. Dr. Patel has nothing to disclose. Dr. Pula has received personal compensation for activities with Bayer, Teva, Lundbeck, and Novartis as a speaker.