Anti-N-methyl-D-aspartate receptor type autoimmune encephalitis with severe pneumonia: a case report

doi:10.5847/wjem.j.1920-8642.2024.024

Abstract

Yi Gu, Xiandong Liu, Tiancao Dong, Qian Yang, Xiaowei Bao, Dongyang Zhao, Lunxian Tang. Anti-N-methyl-D-aspartate receptor type autoimmune encephalitis with severe pneumonia: a case report[J]. World Journal of Emergency Medicine, 2024, 15(2): 142-146.

Figures/Tables 3

Table 1.

Figure 1.

Table 2.

References 20

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Parameters	8^th October	10^th October	13^th October	20^th October	27^th October
Leukocyte count, ×10⁹/L	8.43	9.83	8.18	11.57	8.68
Neutrophils proportion, %	76.6	79.8	79.7	83.4	96.3
Lymphocyte proportion, %	16.3	13.6	12.8	8.7	1.7
C-reactive protein, mg/L	21.45	19.24	77.20	59.86	6.53
Procalcitonin, ng/mL	-	-	0.578	1.080	0.118
pH value of arterial blood	-	-	7.461	7.478	7.504
PaO₂, mmHg	-	-	67.9	55.6	103.8
PaCO₂, mmHg	-	-	29.1	29.8	30.4

Time after admission	Symptoms and intervention
Days 1-2	Symptoms: abnormal behaviors and drowsiness lasting for a week Physical and imaging examination: orientation obstacle and cranial CT showed multiple lacunar infarctions Treatment: aspirin, atorvastatin, and citicoline
Days 3-4	Symptoms: fever, aphasia, and incontinence of feces and urine Laboratory examination: white blood cell count of 9,830 cells/μL and C-reactive protein of 19.04 mg/L Treatment: ceftriaxone and troxerutin
Day 5	The patient was hospitalized in the emergency internal medicine ward
Days 6-14	Imaging examination: chest CT displayed scattered inflammation in the lungs and hydrothorax; brain magnetic resonance angiography showed no positive images; EEG displayed a large amount of irregular θ waves of 5-6 Hz and a few δ waves in the frontotemporal region Laboratory examination: NGS of CSF showed infection with HHV-5; anti-NMDAR antibody of the CSF was 1:3.2; sputum culture revealed infection with Staphylococcus aureus, Acinetobacter baumannii, and Acinetobacter pittii
Days 15-32	Treatment: methylprednisolone, intravenous human immunoglobulin, vancomycin, and colistin sulfate
Outcome	The patient’s symptoms improved, and he was transferred to the rehabilitation hospital on day 33

Anti-N-methyl-D-aspartate receptor type autoimmune encephalitis with severe pneumonia: a case report

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