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Anti-N-methyl-d-aspartate receptor encephalitis after Herpes simplex virus-associated encephalitis: an emerging disease with diagnosis and therapeutic challenges

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Abstract

Introduction

Morbidity and mortality of Herpes simplex virus encephalitis (HSE) remain high. Relapses of neurological signs may occur after initial clinical improvement under acyclovir treatment.

Methods

We report here a case of post-HSE anti-N-methyl-d-aspartate receptor-mediated encephalitis in an adult and perform a systematic search on PubMed to identify other cases in adults.

Results

We identified 11 previously published cases, to discuss diagnostic and therapeutic management. Symptoms in adults are often inappropriate behaviors, confusion and agitation. Diagnosis of anti-NMDA-R encephalitis after HSE is often delayed. Treatment consists in steroids, plasma exchange, and rituximab. Prognosis is often favorable.

Conclusion

Anti-NMDA-R antibodies should be searched in cerebrospinal fluid of patients with unexpected evolution of HSE. This emerging entity reopens the hot debate about steroids in HSE.

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Authors and Affiliations

  1. University Hospital of Saint-Etienne, 55 Avenue Albert Raimond, 42055, Saint-Etienne Cedex 2, France

    Flora Schein, Amandine Gagneux-Brunon, Jean-Christophe Antoine, Sylvie Lavernhe, Sylvie Pillet, Stéphane Paul, Anne Frésard, Claire Boutet, Rémi Grange, Céline Cazorla, Frédéric Lucht & Elisabeth Botelho-Nevers

Authors
  1. Flora Schein
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  2. Amandine Gagneux-Brunon
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  3. Jean-Christophe Antoine
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  4. Sylvie Lavernhe
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  5. Sylvie Pillet
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  6. Stéphane Paul
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  7. Anne Frésard
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  8. Claire Boutet
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  9. Rémi Grange
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  10. Céline Cazorla
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  11. Frédéric Lucht
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  12. Elisabeth Botelho-Nevers
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Corresponding author

Correspondence to Amandine Gagneux-Brunon.

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We do not have any conflict of interest. We did not receive any financial support for this work.

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Schein, F., Gagneux-Brunon, A., Antoine, JC. et al. Anti-N-methyl-d-aspartate receptor encephalitis after Herpes simplex virus-associated encephalitis: an emerging disease with diagnosis and therapeutic challenges. Infection 45, 545–549 (2017). https://doi.org/10.1007/s15010-016-0959-y

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  • DOI: https://doi.org/10.1007/s15010-016-0959-y

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