Prolonged Neuropsychiatric Symptoms in an Adolescent: An Undiagnosed Case of Autoimmune Encephalitis
Sudesh Kumar, Anmol Singh Gill, Randeep GillAbstract
Background:
Autoimmune encephalitis (AIE) is an emerging cause of acute encephalopathy in pediatrics age group. Neuropsychiatric manifestations are predominant in older children, which result in initial presentation to psychiatrists, and diagnosis is often delayed.
Clinical Description:
A 13-year-old girl was admitted with abnormal body movements, followed by loss of consciousness, without any fever, vomiting, loose stools, or trauma. She had a history of abnormal, aggressive behavior for the past 6 months, which was considered psychotic and not evaluated. On examination, the child was conscious, vitals were stable, and systemic examination was unremarkable, except for an aggressive, unruly behavior.
Management and Outcome:
Investigations were mostly normal except for raised erythrocyte sedimentation. Random blood sugar was 110 mg/dL. Cerebral spinal fluid examination showed 3–4 cells/mm 3 , predominantly lymphocytes with sugar low (28.6 mg/dL), mildly raised protein (57.4 mg/dL), and positive anti-N-Methyl-D-aspartic acid receptor antibody. The electroencephalogram was abnormal. The Magnetic Resonance Imaging of the brain showed subcortical hyper intensity in left temporal lobe. The child was thus diagnosed as AIE and was treated with intravenous methyl prednisolone followed by oral prednisolone along with supportive therapy. The child showed dramatic improvement in 2 weeks.
Conclusion:
Neuropsychiatric behavior may be a manifestation of an underlying autoimmune encephalitis, which may remain undiagnosed for months.