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HSV encephalitis-induced anti-NMDAR encephalitis in a 67-year-old woman: report of a case and review of the literature

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Abstract

Herpes simplex virus (HSV) encephalitis can induce an autoimmune encephalitis mediated by autoantibodies against the N-methyl-D-aspartate receptor (NMDAR). Post-HSV NMDAR encephalitis and de novo NMDAR encephalitis have been more commonly described in children and young adults. We describe the case of a 67-year-old woman with post-HSV NMDAR encephalitis and review the relevant literature. Clinical, serological, neurophysiological, and imaging evaluations were undertaken in the evaluation of this patient. A literature review was performed. Nearly 2 months after a typical course of HSV encephalitis confirmed by HSV polymerase chain reaction studies from the spinal fluid and treated with intravenous acyclovir, a 67-year-old woman suffered neurological deterioration. There was no evidence of active HSV infection, but NMDAR antibodies were found in her serum and spinal fluid. The patient improved after initiation of immunosuppressive therapy. All patients who experience new or recurrent neurological symptoms following recovery from HSV encephalitis should be evaluated for post-infectious autoimmune encephalitis, including NMDAR encephalitis.

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Conflict of interest

Nicholas A. Morris, MD, Tamara Kaplan, MD, and Jenny Linnoila, MD, PhD declare that they have no competing interests.

Tracey Cho, MD received compensation as a consultant for Optum Insight, guest editor for Continuum: Lifelong Learning in Neurology, and guest editor for Seminars in Neurology.

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Correspondence to Tamara B. Kaplan.

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Morris, N.A., Kaplan, T.B., Linnoila, J. et al. HSV encephalitis-induced anti-NMDAR encephalitis in a 67-year-old woman: report of a case and review of the literature. J. Neurovirol. 22, 33–37 (2016). https://doi.org/10.1007/s13365-015-0364-9

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  • DOI: https://doi.org/10.1007/s13365-015-0364-9

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