A case of anti-N-methyl-D-aspartate receptor encephalitis with multiple sclerosis-like demyelinated lesions

作者：Takeda Akitoshi^*; Shimada Hiroyuki; Tamura Akiko; Yasui Masaaki; Yamamoto Kei ichi; Itoh Kazuhiro; Ataka Suzuka; Tanaka Sayaka; Ohsawa Masahiko; Hatsuta Hiroyuki; Hirano Makito; Sakamoto Hikaru; Ueno Shuichi; Nakamura Yusaku; Tsutada Tsuyoshi; Miki Takami

来源：Multiple Sclerosis and Related Disorders, 2014, 3(3): 391-397.

DOI：10.1016/j.msard.2013.09.005

• Anti-N-methyl-D-aspartate receptor encephalitis
• Multiple sclerosis
• Neuromyelitis optica
• Brain biopsy
• Demyelination
• CSF antibody titer

Objective: To describe an unusual case of a male patient with anti-N-methyl-o-aspartate receptor (NMDAR) encephalitis who presented with multiple white matter lesions. Brain biopsy of the patient was performed, and follow-up evaluation of the cerebrospinal fluid (CSF) NMDAR antibody titer was implemented. %26lt;br%26gt;Design: Case report. %26lt;br%26gt;Setting: University hospital. %26lt;br%26gt;Patient: A 35-year-old man with anti-NMDAR encephalitis initially presented with fever and psychiatric symptoms. After an initial attack of anti-NMDAR encephalitis, 2 atypical relapses occurred, which presented with myelitis and multifocal white matter lesions; the lesions were open-ring-shaped and partially enhanced. %26lt;br%26gt;Intervention: Analysis of the brain biopsy specimen revealed the presence of demyelinated lesions with discrete borders. Subsequent intravenous methylprednisolone therapy resulted in improvement in the brain lesions. Prednisolone and cyclophosphamide were orally administered thereafter. Clinical progression of the disease paralleled observed changes in the CSF NMDAR antibody titer. %26lt;br%26gt;Conclusion: The demyelinated lesions observed in this case were similar to lesions found in multiple sclerosis. On the basis of our finding that the clinical progression of the disease and the associated symptoms paralleled changes in the CSF NMDAR antibody titer, we speculate that the lesions formed as a result of anti-NMDAR encephalitis.

• 出版日期2014-5