Anti-N-Methyl-D-Aspartate Receptor Encephalitis Triggered by Lyme Disease

• Published in: Canadian journal of neurological sciences 2024-03, Vol.51 (2), p.325-327
• Main Authors: Chang, Yiu-Chia, Budhram, Adrian, Wong, Daniel
• Format: Article
• Language: English
• Subjects: Antibodies; Blood; Cerebrospinal fluid; Electroencephalography; Encephalitis; Immunotherapy; Infections; Letter to the Editor: New Observation; Lyme disease; Magnetic resonance imaging; Memory; Nervous system; Neurological disorders; Patients; Tomography; West Nile virus
• ISSN: 0317-1671; 2057-0155
• DOI: 10.1017/cjn.2022.329

Eight months after his original admission to the hospital, he developed agitation and pressured speech prompting clinical re-evaluation. Patients with anti-NMDAR encephalitis triggered by Lyme disease reported in the literature Martinez et al. 2018 Predkele et al. 2021 Chang et al. 2022 Age 32 74 70 Sex Male Male Male Symptoms indicative of Lyme disease Low-grade fever Left facial palsy and hypesthesia Right facial palsy Testing indicative of Lyme disease Blood and CSF analysis revealed Borrelia burgdorferi IgM and IgG antibodies with elevated CSF antibody index Blood and CSF analysis revealed Borrelia burgdorferi IgM and IgG antibodies with elevated CSF antibody index Blood analysis revealed Borrelia burgdorferi IgM and IgG antibodies; CSF testing for Lyme disease not performed Symptoms indicative of anti-NMDAR encephalitis Behavioural changes, depression, memory loss, dysarthria, auditory hallucinations, irritability and aggressiveness Behavioural and language changes, as well as memory impairment, balance impairment, and sleep disturbances Behavioural change with agitation/aggressiveness, pressured speech Testing indicative of anti-NMDAR encephalitis Positivity for anti-NMDAR by CBA in serum and CSF Positivity for anti-NMDAR by fixed CBA in serum and CSF Positivity for anti-NMDAR by fixed CBA in CSF Time between onset of symptoms indicative of Lyme disease and anti-NMDAR encephalitis Unclear; low-grade fever 4 weeks prior to hospital admission, although had onset of anti-NMDAR encephalitis symptoms preceding hospital admission Unclear; symptoms indicative of Lyme disease noted at time of assessment for anti-NMDAR encephalitis 4 weeks CSF profile Inflammatory; 60 WBC/μL (98% lymphocytes) Inflammatory; 79 WBC/μL (85% agranulocytes) and elevated protein of 1.924 g/L Non-inflammatory MRI findings No acute abnormality No acute abnormality No acute abnormality EEG findings Diffuse delta slowing but no reported epileptiform activity No reported epileptiform activity No focal slowing or epileptiform activity Treatments Ceftriaxone, followed by plasma exchange then IVIG Ceftriaxone, followed by IVMP Ceftriaxone, followed by IVIG and then IVMP Outcome Initial worsening on ceftriaxone, with improvement following immunotherapy; recovered entirely 6 months after discharge from the hospital Initially no marked improvement on ceftriaxone, with improvement noted after first 2 days of IVMP; marked improvement 10 days posttreatment and was discharged from the hospital, w