Anti-N-Methyl-D-Aspartate receptor encephalitis by prior epstein barr infection

Case presentation: Female, 8 years old, previously healthy, referred to our service due 10 days of agitation and excessive crying associated with a fever peak. Evolved seizures, self-harm behavioral changes, dysarthria, visual hallucinations, movement disorders. On admission, presence drowsiness, mental confusion, dyskinetic appendicular orofacial movements. General laboratory tests, cultures, brain magnetic resonance imaging (MRI) without changes. Initial cerebrospinal fluid (CSF) analysis lympho-monocytic pleocytosis serology results. Treatment an antiviral (acyclovir) was started the initial hypothesis infectious encephalitis. Child worsening symptoms, new lowered level consciousness, intubation need. Electroencephalogram (EEG) moderate disorganization background rhythm epileptiform paroxysms. Given patient's clinical deterioration over days, autoimmune encephalitis (AE) made. Presence IgM reagent for Epstein-Barr Virus (EBV) in serum remaining serologies negative. Herpes simplex virus-1 search on negative LQR. The patient received pulse therapy methylprednisolone intravenous immunoglobulin (IVIG). Encephalitis confirmed by positive anti-NMDA receptor (anti-NMDAR) LQR (1:16) blood (1:800). Associated tumors were ruled out. 15 past IVIG, there significant improvement. Currently asymptomatic.