Anti-NMDA receptor encephalitis presenting as atypical anorexia nervosa: an adolescent case report


Since 2007, more than 600 patients have been diagnosed with anti-N-methyl-d-aspartate (NMDA) receptor encephalitis, with almost 40 % of those affected being children or adolescents. In early phases of the illness, this life-threatening disease is characterized by psychiatric symptoms, such as depression, anxiety, obsessions, hallucinations or delusions. Consequently, a high percentage of patients receive psychiatric diagnoses at first, hindering the crucial early diagnosis and treatment of the anti-NMDA receptor encephalitis. We report on a 15-year-old girl initially presenting with pathological eating behaviour and significant weight loss resulting in an (atypical) anorexia nervosa (AN) diagnosis. Her early course of illness, diagnostic process, treatment and short-term outcome are described. This case report aims to raise awareness about the association between anorectic behaviour and anti-NMDA receptor encephalitis and highlight the importance of multidisciplinary teams in child and adolescent services.

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  1. 1.

    Dalmau J, Tuzun E, Wu HY, Masjuan J, Rossi JE, Voloschin A, Baehring JM, Shimazaki H, Koide R, King D, Mason W, Sansing LH, Dichter MA, Rosenfeld MR, Lynch DR (2007) Paraneoplastic anti-N-methyl-d-aspartate receptor encephalitis associated with ovarian teratoma. Ann Neurol 61:25–36. doi:10.1002/ana.21050

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  2. 2.

    Titulaer MJ, McCracken L, Gabilondo I, Armangue T, Glaser C, Iizuka T, Honig LS, Benseler SM, Kawachi I, Martinez-Hernandez E, Aguilar E, Gresa-Arribas N, Ryan-Florance N, Torrents A, Saiz A, Rosenfeld MR, Balice-Gordon R, Graus F, Dalmau J (2013) Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study. Lancet Neurol 12:157–165. doi:10.1016/S1474-4422(12)70310-1

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  3. 3.

    Iizuka T, Yoshii S, Kan S, Hamada J, Dalmau J, Sakai F, Mochizuki H (2010) Reversible brain atrophy in anti-NMDA receptor encephalitis: a long-term observational study. J Neurol 257:1686–1691. doi:10.1007/s00415-010-5604-6

    PubMed Central  Article  PubMed  Google Scholar 

  4. 4.

    Dalmau J, Gleichman AJ, Hughes EG, Rossi JE, Peng X, Lai M, Dessain SK, Rosenfeld MR, Balice-Gordon R, Lynch DR (2008) Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies. Lancet Neurol 7:1091–1098. doi:10.1016/S1474-4422(08)70224-2

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  5. 5.

    Dalmau J, Lancaster E, Martinez-Hernandez E, Rosenfeld MR, Balice-Gordon R (2011) Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. Lancet Neurol 10:63–74. doi:10.1016/S1474-4422(10)70253-2

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  6. 6.

    Iizuka T, Sakai F, Ide T, Monzen T, Yoshii S, Iigaya M, Suzuki K, Lynch DR, Suzuki N, Hata T, Dalmau J (2008) Anti-NMDA receptor encephalitis in Japan: long-term outcome without tumor removal. Neurology 70:504–511. doi:10.1212/01.wnl.0000278388.90370.c3

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  7. 7.

    Deiva K, Pera MC, Maurey H, Chretien P, Archambaud F, Bouilleret V, Tardieu M (2014) Sudden and isolated Broca’s aphasia: A new clinical phenotype of anti NMDA receptor antibodies encephalitis in children. Eur J Paediatr Neurol. doi:10.1016/j.ejpn.2014.06.002

    Google Scholar 

  8. 8.

    Sharma B, Handa R, Prakash S, Nagpal K, Gupta P (2014) Anti-NMDA receptor encephalitis: a neurological disease in psychiatric disguise. Asian J Psychiatry 7:92–94. doi:10.1016/j.ajp.2013.11.018

    Article  Google Scholar 

  9. 9.

    Maneta E, Garcia G (2014) Psychiatric manifestations of anti-NMDA receptor encephalitis: neurobiological underpinnings and differential diagnostic implications. Psychosomatics 55:37–44. doi:10.1016/j.psym.2013.06.002

    Article  PubMed  Google Scholar 

  10. 10.

    Stanley BG, Urstadt KR, Charles JR, Kee T (2011) Glutamate and GABA in lateral hypothalamic mechanisms controlling food intake. Physiol Behav 104(1):40–46. doi:10.1016/j.physbeh.2011.04.046

    CAS  Article  PubMed  Google Scholar 

  11. 11.

    Perogamvros L, Schnider A, Leemann B (2012) The role of NMDA receptors in human eating behavior: evidence from a case of anti-NMDA receptor encephalitis. Cogn Behav Neurol 25:93–97. doi:10.1097/WNN.0b013e31825921a6

    Article  PubMed  Google Scholar 

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The authors would like to thank the patient and her family for their permission to share her interesting case with our national and international colleagues.

Conflict of interest

The authors declare that they have no conflict of interest.

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Corresponding author

Correspondence to Sibylle Winter.

Additional information

D. Mechelhoff and B. M. van Noort contributed equally to this work.

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Mechelhoff, D., van Noort, B.M., Weschke, B. et al. Anti-NMDA receptor encephalitis presenting as atypical anorexia nervosa: an adolescent case report. Eur Child Adolesc Psychiatry 24, 1321–1324 (2015).

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  • Anti-NMDA receptor encephalitis
  • Atypical anorexia nervosa
  • Child and adolescent psychiatry
  • Paediatrics