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Journal of Pediatric Neurology 2019; 17(02): 077-084
DOI: 10.1055/s-0038-1636994
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Pediatric Relapsing Anti-NMDAR Encephalitis Crossing with Tumefactive Demyelinating Lesion

Sudarat Charoensanti
1   Department of Pediatrics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
,
Sutatip Pongcharoen
2   Division of Immunology, Department of Medicine, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
3   Research Center for Academic Excellence in Petroleum, Petrochemical and Advanced Materials, Faculty of Science, Naresuan University, Phitsanulok, Thailand
4   Center of Excellence in Molecular Biotechnology, Faculty of Medical Science, Naresuan University, Phitsanulok, Thailand
,
Metha Apiwattanakul
5   Department of Neurology, Prasat Neurological Institute, Bangkok, Thailand
› Author Affiliations
Further Information

Publication History

18 November 2017

04 February 2018

Publication Date:
16 March 2018 (online)

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Abstract

Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an autoimmune encephalopathy characterized by neuropsychiatric symptoms, autonomic instability, and abnormal movements. Most children who undergo tumor removal and receive appropriate immunosuppressants have substantial neurological improvement. We report a 14-year-old girl with relapsing anti-NMDAR encephalitis who presented with paroxysmal tingling and weakness of the right lower limb. Despite long-term prophylaxis with immunotherapy (azathioprine), tumefactive demyelinating lesion and multifocal subcortical white matter lesions were identified on magnetic resonance imaging, which improved after high doses of steroid therapy. There may be overlap between the clinical manifestations of anti-NMDAR encephalitis and acquired demyelination syndromes in children.

Keywords

anti-NMDAR encephalitis - relapsing - demyelination syndrome - tumefactive demyelinating lesion
 

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