Autoimmune anti-NMDA receptor encephalitis on the background of COVID-19: a clinical case

Background: During the new COVID-19 coronavirus infection pandemic, a growing incidence of autoimmune encephalitis cases has been observed. One of the primary problems related to patients with this highly lethal pathology is its timely early diagnostics and prescription of an optimal individual course of immunotherapy. In a debut of anti-NMDA receptor (inotropic glutamate receptor, selectively binding N-methyl D-aspartate) encephalitis, mental disorders are observed, prompting the initial admission of such patients to a psychiatric hospital. Then, the clinical picture of the disease is characterized by a significant polymorphism. In such cases, it is not always possible to suspect an autoimmune lesion of the nervous system.

Clinical case description: In this article, we present a clinical case of a female patient with serologically confirmed autoimmune encephalitis against the background of the new coronavirus infection (U07.1 according to ICD-10). The disease onset involved psychiatric symptoms; the patient was transferred to the Department of neurology of the VGK BSMP No. 1 Municipal Clinical Hospital of Emergency Care No.1 from the municipal psychiatric hospital, when generalized cerebral symptoms appeared. According to the diagnostic criteria, mental disorders and generalized epileptic seizures are the most significant signs in the verification of autoimmune encephalitis. Autoimmune encephalitis was suspected based on the developed neurological symptoms and generalized epileptic seizures and confirmed by the detected anti-NMDA antibodies in the blood serum. The anti-NMDA antibody analysis in the blood and cerebrospinal fluid is the most informative way of autoimmune encephalitis diagnosis.

Conclusion: Autoimmune encephalitis requires vigilance of physicians of all specialties who may encounter this disease. Timely diagnostic procedures and prescription of pathogenetically justified treatment are of importance.