Dement Neurocogn Disord.  2016 Mar;15(1):24-27. 10.12779/dnd.2016.15.1.24.

Thyroid Autoantibody Positive Anti-N-Methyl-D-Aspartate Receptor Encephalitis

• Jung Y
• Park S
• Son HJ
• Jung DS
• Sa EH
• Lee ST
• Kim ES
• Jung NY
• Kim EJ

• KMID: 2442868
• DOI: http://doi.org/10.12779/dnd.2016.15.1.24

Abstract

BACKGROUND
Hashimoto's encephalopathy (HE) and anti N-methyl-D-aspartate receptor (NMDAR) encephalitis have clinical overlaps.
CASE REPORT
A 70-year-old woman presented with acutely developed confusion, disorientations and psychosis. HE was suspected based on goiter, markedly elevated anti-thyroglobulin and anti-thyroid peroxidase antibody. She was placed on high dose steroid and intravenous immunoglobulins administration, which did not ameliorate her symptoms. After the antibodies to the NMDAR were identified, weekly 500 mg of rituximab with 4 cycles were started. The current followed up indicated a complete recovery.
CONCLUSIONS
The possible associations between NMDAR antibody and autoimmune thyroid antibodies in anti-NMDAR encephalitis with positive thyroid autoantibodies remain unclear. However, a trend toward a higher incidence of NMDAR antibody in patients with autoimmune thyroid antibodies than without has been observed. Cases of encephalitis with only NMDAR antibody (pure anti-NMDAR encephalitis) also occur. Therefore, it is important for clinicians to know the clinical and pathogenic differences between anti-NMDAR encephalitis with positive thyroid autoantibody and pure anti-NMDAR encephalitis for relevant treatment, predicting prognosis, and future follow-up.

Keyword

anti-N-methyl-D-aspartate receptor encephalitis; Hashimoto's encephalopathy; thyroid autoantibody

MeSH Terms

Aged
Anti-N-Methyl-D-Aspartate Receptor Encephalitis*
Antibodies
Autoantibodies
Encephalitis
Female
Follow-Up Studies
Goiter
Humans
Immunoglobulins, Intravenous
Incidence
N-Methylaspartate
Peroxidase
Prognosis
Psychotic Disorders
Thyroid Gland*
Rituximab
Antibodies
Autoantibodies
Immunoglobulins, Intravenous
N-Methylaspartate
Peroxidase

Figure

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  Fig. 1 Fluid-attenuated inversion recovery MR. Images showed no definite abnormalities.

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  Fig. 2 Diffuse enlargement of thyroid was detected on physical examination.

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  Fig. 3 The electroencephalography showed intermittent 2–3 Hz delta background activity in the left hemisphere, suggesting moderate cerebral dysfunction on the left hemisphere.

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  Fig. 4 Brain fluorodeoxyglucose positron emission tomography images demonstrated multifocal hypermetabolism in bilateral inferolateral temporal, parietal, frontal areas and cerebellar vermis.

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