We describe a child with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis who had fever of unknown origin (FUO) without encephalopathy or behavioral change. The main neurological symptoms were tremor, truncal ataxia, and postural hypotension. Anti-NMDAR antibodies were present in serum and cerebrospinal fluid. With intravenous immunoglobulin, she made a complete recovery.Children and adolescents who have fever of unknown origin (FUO), defined as temperature more than 38 degrees Celsius for longer than 14 days, are usually prescribed empiric antimicrobial treatment while the underlying cause is being evaluated. 1 This involves obtaining a detailed travel and symptom history, a physical examination, and an array of investigations for an underlying infection, autoimmune disorder, oncologic or genetic etiology. Infections are the most common etiology, but an increasing number of noninfectious causes are now known. 2 To this list, we would add anti-Nmethyl-D-aspartate (NMDAR) receptor encephalitis.Anti-NMDAR receptor encephalitis is a devastating disease. A short prodromal febrile illness usually precedes a fairly characteristic neurological syndrome involving psychiatric symptoms or mood change, encephalopathy, movement disorder, speech or language difficulties, and seizures. Some patients have autonomic dysfunction, respiratory insufficiency, or cerebellar symptoms. 3,4 We report a patient with anti-NMDAR encephalitis who primarily had FUO without prominent neuropsychiatric symptoms or encephalopathy and had less typical disease manifestations.
| CASE REPORTThis is a previously well 13-year-old girl who presented to the hospital with a 3-day history of fever, headache, dizziness,