Acute Psychosis Due to Anti-N-Methyl D-Aspartate Receptor Encephalitis Following COVID-19 Vaccination: A Case Report

Abstract

Anti-N-methyl D-aspartate (NMDA) receptor (anti-NMDAR) encephalitis has been reported after SARS-CoV-2 infection, but not after SARS-CoV-2 vaccination. We report the first known case of anti-NMDAR encephalitis after SARS-CoV-2 immunization in a young female presenting with acute psychosis, highlighting a rare potential immunological complication of vaccination against SARS-CoV-2 that is currently being distributed worldwide. The patient presented initially with anxiety and hypochondriacal delusions which progressed to psychosis and catatonia but returned to baseline with aggressive immunomodulatory therapy consisting of intravenous immunoglobulin, high-dose glucocorticoids, and rituximab. This study highlights that the workup of acute psychosis should include establishing a history of recent vaccination followed by a thorough neurological assessment, including for anti-NMDAR antibodies in blood and cerebrospinal fluid.

Psychiatric adverse reactions to COVID-19 vaccines: A rapid review of published case reports

“…In some individuals, this may lead to cytokine storm and NMDA receptor hypofunction with a resultant increase in dopamine; this may trigger a psychotic state ( Grover et al, 2022a ). Other hypothesized causes for psychosis post-vaccination include anti-NMDA encephalitis ( Flannery et al, 2021 , Hilaire et al, 2021 ). Majority of the index cases patients had no prior history of psychiatric illness before receipt of vaccine.…”

“… 5. Flannery et al, 2021 20 s/F First dose of the Pfizer-BioNTech COVID-19 vaccine (mRNA Vaccine) Psychosis 1 week Decreased sleep, anxiety, auditory hallucinations, catatonia. 6.…”

“…Similarly, Giné-Servén et al described two cases of acute psychosis within a week following receipt of AstraZeneca vaccine ( Giné-Servén et al, 2021 ). Another case of acute psychosis with catatonic features in a 20-year-old female was reported following 1 st dose of the Pfizer-BioNTech COVID-19 vaccine ( Flannery et al, 2021 ). Notably, all these reports described psychosis after Covid vaccination in young individuals.…”

Post-Vaccinal Encephalitis with Early Relapse after BNT162b2 (COMIRNATY) COVID-19 Vaccine: A Case Report

“…AE post-vaccination against COVID-19 is a rare entity, and its incidence is not yet defined. In previous cases, the encephalitis symptoms’ appearance within three weeks after vaccination has been registered, defining this time as a relevant period [ 6 , 9 , 11 , 12 , 13 , 14 , 15 ] ( Table 1 ). In our case, the patient presented a subacute onset of altered content of consciousness, confusion, did not recognize family members, presented episodes of aggressiveness and difficulty walking, which is comparable to that observed in previous cases of autoimmune encephalopathy [ 6 , 9 , 13 ].…”

COVID−19, Anti-NMDA Receptor Encephalitis and MicroRNA

“…In addition to these reported cases of COVID-19 infection associated with anti-NMDA receptor encephalitis, a case of anti-NMDA receptor encephalitis triggered by COVID-19 vaccination was reported. A young female presented with acute psychosis, motor dysfunction and a transient bout of aphasia after receiving her first dose of the Pfizer-BioNTech COVID-19 vaccine ( 18 ). Later, this patient was diagnosed with anti-NMDA receptor encephalitis by a CSF test.…”