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Infection
Published in: Infection 4/2017

01-08-2017 | Case Report

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

Authors: 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

Published in: Infection | Issue 4/2017

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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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Metadata
Title
Anti-N-methyl-d-aspartate receptor encephalitis after Herpes simplex virus-associated encephalitis: an emerging disease with diagnosis and therapeutic challenges
Authors
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
Publication date
01-08-2017
Publisher
Springer Berlin Heidelberg
Published in
Infection / Issue 4/2017
Print ISSN: 0300-8126
Electronic ISSN: 1439-0973
DOI
https://doi.org/10.1007/s15010-016-0959-y

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