The presence of human respiratory syncytial virus in the cerebrospinal fluid of a child with Anti-N-methyl-D-aspartate receptor encephalitis of unknown trigger

• Published in: Virology journal 2023-02, Vol.20 (1), p.34-34, Article 34
• Main Authors: Yu, Siyan, Hua, Ying, Qian, Jun, Sun, Mingxia, Kang, Yan-Jun
• Format: Article
• Language: English
• Subjects: Anti-N-methyl-D-aspartate receptor encephalitis; Anti-N-Methyl-D-Aspartate Receptor Encephalitis - diagnosis; Anti-N-Methyl-D-Aspartate Receptor Encephalitis - drug therapy; Antibodies; Antigens; Ataxia; Atrophy; Autoantibodies; Autoimmune diseases; Case Report; Cerebellum; Cerebrospinal fluid; Children; Children & youth; Development and progression; Diagnosis; Encephalitis; Etiology; Genomes; Glutamic acid receptors; Glutamic acid receptors (ionotropic); Human respiratory syncytial virus; Humans; Magnetic Resonance Imaging; Male; N-Methyl-D-aspartic acid receptors; Neoplasm Recurrence, Local; Nervous system; Neuroimaging; Nucleotide sequence; Pediatrics; Phylogenetics; Receptors, N-Methyl-D-Aspartate; Respiratory syncytial virus; Respiratory Syncytial Virus, Human; Respiratory tract diseases; Risk factors; Skull; Taxonomy; Testing; Transcriptome sequencing; Transcriptomes; Tumors; Viral infections; Viruses
• ISSN: 1743-422X; 1743-422X
• DOI: 10.1186/s12985-023-01997-1

Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an important type of brain inflammation caused by autoantibody. As one of the primary agents responsible for respiratory tract infection, the human respiratory syncytial virus (hRSV) has also been reported to be capable of causing extrapulmonary diseases. Here, we first describe a case of anti-NMDAR encephalitis when hRSV was shown to be present in the cerebrospinal fluid. The child was noted to have ataxia and positive anti-NMDA receptors in the cerebrospinal fluid, diagnosed as anti-NMDA receptor encephalitis in combination with cranial MRI images. After high-dose hormone pulse therapy and medication, the disease improved, and he was discharged. However, a relapse occurred almost a year later, and the cranial MRI imaging showed progressive cerebellar atrophy. An hRSV strain from group B was detected in his cerebrospinal fluid, and the whole genome sequence was recovered using transcriptome sequencing. To our knowledge, this is the first report of hRSV being found in the cerebrospinal fluid of a patient with anti-NMDAR encephalitis. Even though more clinical records and experimental evidence are needed for validation, this work expands the types of diseases linked to hRSV and the likely cause of anti-NMDAR encephalitis.