(061) Anti-NMDA Receptor Encephalitis Associated with COVID-19: A Case Report

Trainee Involvement: No

Introduction

Encephalitis is a rare complication of COVID-19 but is associated with increased morbidity and mortality (Siow et al., 2021). Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis associated with COVID-19 infection has been reported, although there continues to be a paucity of data in the literature (Vasilevska et al., 2021). We describe a case of acute-onset mania with psychotic features found to be secondary to anti-NMDA receptor encephalitis in the context of a recent COVID-19 infection.

Case Presentation

A 45-year-old Caucasian female with no prior psychiatric history and a past medical history of rheumatoid arthritis presented to the emergency department with paranoia, poor sleep, and erratic behavior following diagnosis of COVID-19 two weeks prior. Initial medical workup demonstrated increased inflammatory markers and mild CSF pleocytosis. MR brain showed leptomeningeal enhancement but was otherwise unremarkable. She was initiated on empiric treatment with IV immunoglobulin and high-dose IV steroids. She demonstrated significant improvement after day three of empiric immunotherapy, and her neuropsychiatric symptoms resolved by day five at which time she was discharged home with outpatient follow-up. After discharge, her CSF autoimmune panel returned positive for NMDA receptor antibodies.

Conclusion:

This rare case demonstrates that individuals with acute-onset neuropsychiatric symptoms, particularly in the setting of recent infection with COVID-19, should be evaluated for possible autoimmune etiologies and considered for initiation of immunotherapy for empiric treatment.

References:

Siow, I., Lee, K. S., Zhang, J. J. Y., Saffari, S. E., & Ng, A. (2021, Oct). Encephalitis as a neurological complication of COVID-19: A systematic review and meta-analysis of incidence, outcomes, and predictors. Eur J Neurol, 28(10), 3491-3502. https://doi.org/10.1111/ene.14913

Vasilevska, V., Guest, P. C., Bernstein, H. G., Schroeter, M. L., Geis, C., & Steiner, J. (2021, Oct 28). Molecular mimicry of NMDA receptors may contribute to neuropsychiatric symptoms in severe COVID-19 cases. J Neuroinflammation, 18(1), 245. https://doi.org/10.1186/s12974-021-02293-x