Following a search the clinical librarian team did recently, here is some reading around autoimmune encephalitis: Schubert, J. et al (2018) Management and prognostic markers in patients with autoimmune encephalitis requiring ICU treatment, Neurology Neuroimmunology & Neuroinflammation, 6(1), e514.
Abstract Objective: This case describes antibody-verified anti-N-methyl-D-aspartate (anti-NMDA) receptor encephalitis in a previously healthy 7 month-old infant female presenting within 48 hours of receiving an influenza booster vaccination during her first influenza season. Background: A previously healthy 7 month old infant female presented with acute onset of altered mental status, decreased activity, roving eye movements, and opisthotonic posturing within 48 hours of receiving an influenza booster vaccination. She was initially diagnosed with acute demyelinating encephalomyelitis (ADEM) and treated with a short burst of corticosteroids followed by a taper. Symptoms subjectively improved during steroid therapy but did not persist, prompting further diagnostic evaluations. Anti-NMDA receptor encephalitis was confirmed by cerebrospinal fluid antibody titer 68 days after onset of symptoms. Treatment was then undertaken with serial courses of intravenous immunoglobulin (IVIG) and rituximab. The patient’s hospital course was protracted, and she required utilization of intensive care unit resources due to aspiration risk, surgical placement of nutritional and vascular access devices, and paroxysmal autonomic hyperactivity (PAH). Minimal improvement in her neurologic exam was observed at time of hospital discharge and may be due to delayed start of treatment, as well as the cumulative effect of unrecognized seizures early in her illness course. Conclusions: This case describes the youngest patient with anti-NMDA receptor encephalitis yet reported, and the first to suggest correlation with recent influenza vaccination. As higher likelihood of neurologic recovery is associated with early initiation of treatment, providers are encouraged to consider autoimmune neurologic disorders like anti-NMDA receptor encephalitis when mental status abnormalities and developmental regression persist, regardless of patient age. Disclosure: Dr. Cartisano has nothing to disclose. Dr. Kicker has nothing to disclose.