Pediatric anti-NMDA receptor encephalitis associated with COVID-19

Abstract

Anti-N-methyl-D-aspartate receptor encephalitis is a clinical condition characterized by acute behavioral and mood changes, abnormal movements, autonomic instability, seizures, and encephalopathy. We describe a 7-year-old boy diagnosed with autoimmune encephalitis due to NMDAR antibody in association with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease 2019) (COVID-19), without pulmonary involvement or fever. The patient presented with acute ataxia, rapidly developed encephalopathy, and autoimmune encephalitis was suspected. Steroid treatment was withheld because of lymphopenia and intravenous immunoglobulin was started. The absence of clinical response prompted plasmapheresis and, when lymphocyte counts improved, pulse steroid treatment was applied. The latter was followed by significant improvement and the patient was discharged in a conscious and ambulatory state. Autoimmune encephalitis should be considered in the presence of neurological symptoms accompanying SARS-CoV-2 infection and steroid treatment should be preferred unless limited by contraindications.

Anti-GAD associated post-infectious cerebellitis after COVID-19 infection

“…These findings confirm that high titer anti-GAD seropositivity is associated with post-infectious cerebellar syndrome in our case. Besides our findings, anti-amphiphysin, anti-Caspr2, anti-GD1b, and anti-NMDAR antibodies related to neurological disorders after SARS-CoV-2 infection have been reported in the literature, suggesting that SARS-CoV-2 infection might trigger autoimmunity [4,6,[28][29][30]. However, it seems complicated to establish a direct pathogenetic relationship between SARS-CoV-2 infection and anti-GADassociated autoimmune cerebellitis.…”

“…In contrarily to our case, the presentation of cerebellar ataxia was concomitant with COVID-19 infection, and SARS-CoV-2 rt-PCR test was found positive in CSF [25]. Although autoantibody screening was performed in the majority of cases, anti-amphiphysin, anti-NMDAR antibodies, and autoantibodies directed against the nuclei of [4,6,17]. In the reported cases in which patients who had SARS-CoV-2 rt-PCR test were positive either in CSF or nasopharyngeal swabs, it indicates cerebellar syndrome is related to the infectious process.…”

Potential Cross-Links of Inflammation With Schizophreniform and Affective Symptoms: A Review and Outlook on Autoimmune Encephalitis and COVID-19

“…This mimicry may lead to the generation of IgG antibodies against the NMDAR subunits after SARS-CoV-2 infection. Recent case reports describing the development of NMDAR encephalitis in temporal association with SARS-CoV-2 positivity support this hypothesis (46)(47)(48)(49)(50)(51). Activation of TH17 cells in COVID-19 sufferers may be a facilitating factor, as this has generally been associated with the occurrence of autoimmune diseases.…”

Update 2021: COVID-19 aus Sicht der Neurologie

“…Berichte einer limbischen Enzephalitis bzw. einer NMDA-R-Enzephalitis [17,18] werden durch Nachweis antineuronaler Antikörper im Liquor und Serum unterstützt [19] und könnten auch im Rahmen langanhaltender Symptome eine Rolle spielen. Somit erscheint eine autoimmune/parainfektiöse Genese einer SARS-CoV-2-assoziierten Enzephalitis aktuell wahrscheinlicher als eine direkte Virusinfektion.…”