ABSTRACT
Objective:
To analyze the clinical presentations and diagnostic and
treatment process of one
patient with
autoimmune encephalitis(AE)with double positive anti-
N-methyl-D-aspartate receptor(NMDAR)and anti-γ-
aminobutyric acid B receptor(GABABR)
secondary to
herpes simplex virus encephalitis(HSVE),and to improve the clinicians'
awareness of this
disease.
Methods:
The clinical data of one AE
patient with double positive anti-NMDAR and anti-GABABR
secondary to HSVE were collected,the diagnostic and
therapeutic processes were summarized,and the relevant
literatures were reviewed.
Results:
The
patient,a 36-year-old
male,developed a
headache followed by
limb convulsions,and progressed to disturbed
consciousness.After admission,the routine
biochemistry of the
cerebrospinal fluid(CSF)was abnormal,and the
herpes simplex virus-1(
HSV-1)
IgG antibody showed positive in the CSF;both CSF and
serum tests for NMDAR
antibodies were positive;the
head magnetic resonance imaging(MRI)results showed abnormal signals in the right occipital
white matter,leading to the
diagnosis of HSVE
secondary to
anti-NMDAR encephalitis.Several months later,the
patient experienced psychiatric
behavior abnormalities,
cognitive dysfunction,and
sleep disorders,and both the
serum NMDAR and GABABR
antibodies showed positive results,prompting the
diagnosis of HSVE
secondary anti-NMDAR encephalitis and anti-GABABR
encephalitis.
After treatment with
steroid pulse therapy and
intravenous immunoglobulin(
IVIG),the
patient's condition was improved and the
patient was discharged.At one-year follow-up,the
patient's psychiatric symptoms had completely resolved,leaving
mild cognitive impairment.
Conclusion:
If the clinical symptoms of the
patients recovering from
antiviral treatment for HSVE is worsened,
secondary AE should be highly suspected;it is important to complete
autoimmunity antibody testing as soon as possible for the
early diagnosis and
treatment to improve the
prognosis of the
patient.
