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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
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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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