NMDARAb positive autoimmune encephalitis reversible with immunoglobulin and plasma exchange in a young female in Sri Lanka: A case report and literature review

Background NMDARAb encephalitis is a neuroautoimmune disease which has a younger onset and a female preponderance. It is a multistage disease with predominant neurological and psychiatric manifestations. Early diagnosis and treatment give a favourable outcome since the disease is treatment responsive and reversible. Case presentation A 35 years old Sri Lankan lady on a background history of hypothyroidism admitted to our hospital with high grade fever and behavioral changes. Later she developed progressive deterioration of symptoms with new onset of fits and status epilepticus along with autonomic instability where she needed elective intubation and ventilation. She had no previous similar episodes, no features of connective tissue disorders or any psychiatric disorder. MRI brain and EEG suggested acute encephalitis and NMDA receptor antibody was positive in CSF. Specific treatments started and she was well responded to it. Conclusion Clinicians should be vigilant for the early diagnosis of NMDARAb encephalitis which is a multistage disease. Early suspecting of the disease by analyzing symptoms, early confirmation by proper investigations and starting proper treatments in early stage will give a favourable outcome.