A 3-Year-Old Boy with Seizures

Background: First described in 2007, Anti-NMDA Receptor Encephalitis is an autoimmune disease caused by immunoreactivity against the NR1/NR2 subunit of the NMDA receptor in the central nervous system. According to the California Encephalitis Project, Anti-NMDA was a more common presentation of encephalitis than viral causes. Case Presentation: A 3-year-old presents to the ER with a possible seizure and recent history of decreased language output and abnormal body stiffness with flexed arms and shaking movements that is prominent on the left side. His initial ER presentation shows signs of fever with unremarkable physical exam, labs and imaging. After no overnight seizures, he was discharged home. A week later, he developed mood lability and other behavioral changes. His second ER presentation shows lymphocytic pleocytosis and a brain MRI shows signs of cerebral inflammatory processes with bilateral non-specific hyperintense lesions. He was started on steroids and IVIG based on the suspicion of Anti-NMDA Receptor Encephalitis. On the 8th day, serum and CSF assays came back positive for the anti-NMDA Receptor antibodies. He continued to receive seizure medications to control his symptoms and was discharged 3 months later to in-patient rehab. Conclusion: This case presents a unique presentation of Anti-NMDA Receptor Encephalitis that was found in a young male instead of the typical tumor associated disease in a young female. This case study emphasizes the need to test for anti-NMDA Receptor antibodies when evaluating young patients with signs of encephalitis.