Herpes simplex virus-1 encephalitis can trigger anti-NMDA receptor encephalitis: case report.

Leypoldt, Frank; Titulaer, Maarten J; Aguilar, Esther; Walther, Janine; Bönstrup, Marlene; Havemeister, Stefanie; Teegen, Bianca; Lütgehetmann, Marc et al. · Neurology · 2013

case_report · Level V

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Abstract

Relapsing symptoms post herpes simplex virus 1 (HSV) encephalitis (HSVE) usually occur a few weeks after viral therapy and represent either 1) a true viral relapse of HSVE (CSF PCR positive for HSV, new necrotic lesions on brain MRI, and response to acyclovir therapy) or 2) a disorder postulated to be immune-mediated (CSF negative for HSV, no new necrotic lesions, and no response to acyclovir).<sup>1,2</sup> It has been suggested that this immune-mediated disorder may be related to NMDA receptor (NMDAR) antibodies,<sup>3</sup> and we recently reported a child in whom relapsing symptoms post HSVE were the presentation of anti-NMDAR encephalitis.<sup>4</sup> We report an adult with this disorder, demonstrate that synthesis of NMDAR antibodies began after HSVE, and show that relapsing symptoms were due to steroid-responsive anti-NMDAR encephalitis.

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