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March 2019; 6 (2) Clinical/Scientific NotesOpen Access

Anti-NMDAR encephalitis with concomitant varicella zoster virus detection and nonteratomatous malignancy

Preeti A. Prakash, Jingxiao Jin, Kanwal Matharu, Tanu Garg, Wendy C. Tsai, Purvesh Patel, Jill E. Weatherhead, Joseph S. Kass
First published January 9, 2019, DOI: https://doi.org/10.1212/NXI.0000000000000537
Preeti A. Prakash
From the Department of Internal Medicine (P.A.P., K.M.), Department of Neurology (J.J., T.G., J.S.K.), Department of Anesthesia (W.C.T.), and Department of Pulmonary, Critical Care, and Sleep Medicine (P.P.), Baylor College of Medicine; and National School of Tropical Medicine (J.E.W.), Baylor College of Medicine, Houston, TX.
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Jingxiao Jin
From the Department of Internal Medicine (P.A.P., K.M.), Department of Neurology (J.J., T.G., J.S.K.), Department of Anesthesia (W.C.T.), and Department of Pulmonary, Critical Care, and Sleep Medicine (P.P.), Baylor College of Medicine; and National School of Tropical Medicine (J.E.W.), Baylor College of Medicine, Houston, TX.
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Kanwal Matharu
From the Department of Internal Medicine (P.A.P., K.M.), Department of Neurology (J.J., T.G., J.S.K.), Department of Anesthesia (W.C.T.), and Department of Pulmonary, Critical Care, and Sleep Medicine (P.P.), Baylor College of Medicine; and National School of Tropical Medicine (J.E.W.), Baylor College of Medicine, Houston, TX.
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Tanu Garg
From the Department of Internal Medicine (P.A.P., K.M.), Department of Neurology (J.J., T.G., J.S.K.), Department of Anesthesia (W.C.T.), and Department of Pulmonary, Critical Care, and Sleep Medicine (P.P.), Baylor College of Medicine; and National School of Tropical Medicine (J.E.W.), Baylor College of Medicine, Houston, TX.
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Wendy C. Tsai
From the Department of Internal Medicine (P.A.P., K.M.), Department of Neurology (J.J., T.G., J.S.K.), Department of Anesthesia (W.C.T.), and Department of Pulmonary, Critical Care, and Sleep Medicine (P.P.), Baylor College of Medicine; and National School of Tropical Medicine (J.E.W.), Baylor College of Medicine, Houston, TX.
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Purvesh Patel
From the Department of Internal Medicine (P.A.P., K.M.), Department of Neurology (J.J., T.G., J.S.K.), Department of Anesthesia (W.C.T.), and Department of Pulmonary, Critical Care, and Sleep Medicine (P.P.), Baylor College of Medicine; and National School of Tropical Medicine (J.E.W.), Baylor College of Medicine, Houston, TX.
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Jill E. Weatherhead
From the Department of Internal Medicine (P.A.P., K.M.), Department of Neurology (J.J., T.G., J.S.K.), Department of Anesthesia (W.C.T.), and Department of Pulmonary, Critical Care, and Sleep Medicine (P.P.), Baylor College of Medicine; and National School of Tropical Medicine (J.E.W.), Baylor College of Medicine, Houston, TX.
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Joseph S. Kass
From the Department of Internal Medicine (P.A.P., K.M.), Department of Neurology (J.J., T.G., J.S.K.), Department of Anesthesia (W.C.T.), and Department of Pulmonary, Critical Care, and Sleep Medicine (P.P.), Baylor College of Medicine; and National School of Tropical Medicine (J.E.W.), Baylor College of Medicine, Houston, TX.
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Citation
Anti-NMDAR encephalitis with concomitant varicella zoster virus detection and nonteratomatous malignancy
Preeti A. Prakash, Jingxiao Jin, Kanwal Matharu, Tanu Garg, Wendy C. Tsai, Purvesh Patel, Jill E. Weatherhead, Joseph S. Kass
Neurol Neuroimmunol Neuroinflamm Mar 2019, 6 (2) e537; DOI: 10.1212/NXI.0000000000000537

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    Figure Time course of the patient's diagnostics and treatment

    The patient initially presented to an outside hospital for altered behavior and was discharged home with a psychiatric diagnosis. When she continued to deteriorate, she presented to our hospital with breath-holding spells, encephalopathy, and dysautonomia. The patient completed a 5-day course of IVMP and IVIG for presumed anti-NMDAR encephalitis. She was initially started on broad-spectrum antibiotics and acyclovir, which were discontinued after a negative HSV PCR. Once her CSF returned positive for VZV, she was started on a 21-day course of acyclovir. HSV = herpes simplex virus; IVIG = intravenous immunoglobulin; IVMP = intravenous methylprednisolone; LP = lumbar puncture; VZV = varicella zoster virus.

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