Nonparaneoplastic anti-NMDA receptor encephalitis in an adolescent girl: a case report.

Anti-N-methyl D-aspartate (NMDA) receptor encephalitis is an autoimmune neurologic disorder that classically presents with psychiatric, neurologic, and autonomic symptoms, often with a viral prodrome. Case presentation: A 17-year-old female presented to the hospital with an 11-day history of fever, altered behavior, abnormal body movements, and altered sensorium. Upon examination, she was found to be febrile, tachycardic, and tachypneic, with a Glasgow Coma Scale score of 8. Discussion: The diagnosis of anti-NMDA receptor encephalitis is usually confirmed by the presence of anti-NMDA receptor antibodies in the cerebrospinal fluid. The first-line treatment options include steroids, intravenous immunoglobulin, and plasmapheresis, while second-line therapies such as rituximab and cyclophosphamide may be necessary for some patients. While most patients respond well to treatment, complications can arise, and as in this case, death can occur. Conclusion: New onset symptoms like alteration in behavior, abnormal body movement, altered sensorium, and psychiatric symptoms in a young female should raise suspicion of this disease. Immunotherapy is promising; however, anticipation and management of complication are essential in reducing mortality.

Torsed gangrenous Meckel's diverticulum causing gangrenous ileal segment: A rare case report of small bowel obstruction in children.

INTRODUCTION: Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal system. It is caused by an incomplete obliteration of the vitelline duct. Rarely, it can present with complications like torsion and gangrene formation. CASE PRESENTATION: A 13-year previously healthy girl presented with sudden onset periumbilical pain and bilious vomiting who was subsequently diagnosed with Meckel's diverticulum. Intraoperatively, torsed gangrenous diverticulum forming band adhesion was found. Resection of Meckel's diverticulum along with gangrenous ileal segment followed by ileoileal anastomosis was done. DISCUSSION: Axial torsion of Meckel's diverticulum with gangrene formation is a rare occurrence. Mesodiverticular band adhesion along with herniation of small bowel segments under it endangers viability of herniating segments. Preoperative diagnosis of complicated MD is difficult as it mimics other common acute abdominal conditions. CT scan and enteroclysis are imaging modalities of choice. Surgical resection of MD along with resection and anastomosis of gangrenous bowel segment results in complete cure. CONCLUSION: Meckel's diverticulum with complications should be kept in the differential of acute abdominal conditions presenting with atypical symptoms. Surgical resection ensures complete cure.