Two Cases of Late-Onset Anti-NMDAr Auto-Immune Encephalitis After Herpes Simplex Virus 1 Encephalitis
Context: Encephalitis due to herpes simplex virus 1 (HSV-1) was described as a potential trigger for the development of anti-N-methyl-D-aspartate receptor (NMDAr) auto-immune encephalitis (AIE) within a few days to a few weeks after the infection.Methods: We assessed clinical, radiological, and biol...
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doaj-a63f44e37c174c8b8f612b41bd41a99b2020-11-25T02:11:45ZengFrontiers Media S.A.Frontiers in Neurology1664-22952020-02-011110.3389/fneur.2020.00038494839Two Cases of Late-Onset Anti-NMDAr Auto-Immune Encephalitis After Herpes Simplex Virus 1 EncephalitisGuillaume Dorcet0Marie Benaiteau1Chloé Bost2Chloé Bost3Catherine Mengelle4Fabrice Bonneville5Fabrice Bonneville6Guillaume Martin-Blondel7Guillaume Martin-Blondel8Jérémie Pariente9Jérémie Pariente10Département de Neurologie, Hôpital Pierre Paul Riquet, CHU de Toulouse, Toulouse, FranceDépartement de Neurologie, Hôpital Pierre Paul Riquet, CHU de Toulouse, Toulouse, FranceLaboratoire d'Immunologie, Institut Fédératif de Biologie, CHU de Toulouse, Toulouse, FranceINSERM U1043 – CNRS UMR 5282, Centre de Physiopathologie Toulouse-Purpan, Toulouse, FranceLaboratoire de Virologie, Institut Fédératif de Biologie, CHU de Toulouse, Toulouse, FranceService de Neuroradiologie, Hôpital Pierre Paul Riquet, CHU de Toulouse, Toulouse, FranceINSERM: ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, FranceINSERM U1043 – CNRS UMR 5282, Centre de Physiopathologie Toulouse-Purpan, Toulouse, FranceService de Maladies Infectieuses et Transmissibles, Bâtiment Urgences Réanimation Médecine, CHU de Toulouse, Toulouse, FranceDépartement de Neurologie, Hôpital Pierre Paul Riquet, CHU de Toulouse, Toulouse, FranceINSERM: ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, FranceContext: Encephalitis due to herpes simplex virus 1 (HSV-1) was described as a potential trigger for the development of anti-N-methyl-D-aspartate receptor (NMDAr) auto-immune encephalitis (AIE) within a few days to a few weeks after the infection.Methods: We assessed clinical, radiological, and biological diagnoses process, treatment response, and evolution.Cases Reported: We report here cases of a 71-year-old man and a 57-year-old woman presenting anti-NMDAr AIE, respectively, 12 and 7 months after HSV-1 encephalitis. In both cases, the onset was brisk, and the symptoms were mainly neuropsychiatric (paranoid delirium, Capgras, and Cotard syndromes) and cognitive, with anterograde amnesia. Relapse of HSV encephalitis, epilepsy, and paraneoplastic neurologic syndromes were excluded. The clinical response to first-line treatments composed of intravenous immunoglobulins and high-dose corticosteroids was poor, whereas significant improvement was noticed after rituximab induction.Conclusion: Post-herpetic anti-NMDAr AIE could arise several months after infection. Clinicians must be aware of this possibility, particularly if cognitive and/or psychiatric symptoms occurred after a remitting period. In our two cases, only rituximab was associated with clinical improvement.https://www.frontiersin.org/article/10.3389/fneur.2020.00038/fullherpetic meningoencephalitisherpes simplexautoimmune encephalitisanti-NMDA antibodiescerebrospinal fluid |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Guillaume Dorcet Marie Benaiteau Chloé Bost Chloé Bost Catherine Mengelle Fabrice Bonneville Fabrice Bonneville Guillaume Martin-Blondel Guillaume Martin-Blondel Jérémie Pariente Jérémie Pariente |
spellingShingle |
Guillaume Dorcet Marie Benaiteau Chloé Bost Chloé Bost Catherine Mengelle Fabrice Bonneville Fabrice Bonneville Guillaume Martin-Blondel Guillaume Martin-Blondel Jérémie Pariente Jérémie Pariente Two Cases of Late-Onset Anti-NMDAr Auto-Immune Encephalitis After Herpes Simplex Virus 1 Encephalitis Frontiers in Neurology herpetic meningoencephalitis herpes simplex autoimmune encephalitis anti-NMDA antibodies cerebrospinal fluid |
author_facet |
Guillaume Dorcet Marie Benaiteau Chloé Bost Chloé Bost Catherine Mengelle Fabrice Bonneville Fabrice Bonneville Guillaume Martin-Blondel Guillaume Martin-Blondel Jérémie Pariente Jérémie Pariente |
author_sort |
Guillaume Dorcet |
title |
Two Cases of Late-Onset Anti-NMDAr Auto-Immune Encephalitis After Herpes Simplex Virus 1 Encephalitis |
title_short |
Two Cases of Late-Onset Anti-NMDAr Auto-Immune Encephalitis After Herpes Simplex Virus 1 Encephalitis |
title_full |
Two Cases of Late-Onset Anti-NMDAr Auto-Immune Encephalitis After Herpes Simplex Virus 1 Encephalitis |
title_fullStr |
Two Cases of Late-Onset Anti-NMDAr Auto-Immune Encephalitis After Herpes Simplex Virus 1 Encephalitis |
title_full_unstemmed |
Two Cases of Late-Onset Anti-NMDAr Auto-Immune Encephalitis After Herpes Simplex Virus 1 Encephalitis |
title_sort |
two cases of late-onset anti-nmdar auto-immune encephalitis after herpes simplex virus 1 encephalitis |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Neurology |
issn |
1664-2295 |
publishDate |
2020-02-01 |
description |
Context: Encephalitis due to herpes simplex virus 1 (HSV-1) was described as a potential trigger for the development of anti-N-methyl-D-aspartate receptor (NMDAr) auto-immune encephalitis (AIE) within a few days to a few weeks after the infection.Methods: We assessed clinical, radiological, and biological diagnoses process, treatment response, and evolution.Cases Reported: We report here cases of a 71-year-old man and a 57-year-old woman presenting anti-NMDAr AIE, respectively, 12 and 7 months after HSV-1 encephalitis. In both cases, the onset was brisk, and the symptoms were mainly neuropsychiatric (paranoid delirium, Capgras, and Cotard syndromes) and cognitive, with anterograde amnesia. Relapse of HSV encephalitis, epilepsy, and paraneoplastic neurologic syndromes were excluded. The clinical response to first-line treatments composed of intravenous immunoglobulins and high-dose corticosteroids was poor, whereas significant improvement was noticed after rituximab induction.Conclusion: Post-herpetic anti-NMDAr AIE could arise several months after infection. Clinicians must be aware of this possibility, particularly if cognitive and/or psychiatric symptoms occurred after a remitting period. In our two cases, only rituximab was associated with clinical improvement. |
topic |
herpetic meningoencephalitis herpes simplex autoimmune encephalitis anti-NMDA antibodies cerebrospinal fluid |
url |
https://www.frontiersin.org/article/10.3389/fneur.2020.00038/full |
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