BIZARRE BEHAVIORS: AUTOIMMUNE ENCEPHALITIS MASQUERADING AS A PSYCHIATRIC SYNDROME

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: N-methyl-D-aspartate (NMDA) receptor antibody encephalitis, a type of autoimmune first described in 2007, is predominant females with female to male ratio 8:2 and about 37% patients being younger than 18 years at presentation.[1,2] It considered part paraneoplastic syndrome, as more half the cases have an underlying malignancy, ovarian teratoma most common.[3,4] CASE PRESENTATION: A 20 year old asthma was brought into Emergency Department for seizures. He checked himself behavioral health facility bizarre behavior. received chlorpromazine, causing generalized tonic clonic seizure. Lorazepam Levetiracetam. Continuous electroencephalogram showed no further seizure activity CT head non-diagnostic any structural abnormalities. afebrile tachycardic on examination, along him being, initially unrousable verbal well tactile stimuli. Eventually he developed aggressive mannerism, requiring 4 point tough restraints. Not controlled lorazepam haloperidol, Dexmedotomide drip started.Laboratory data including urine drug screen unremarkable except elevated CK (3127 U/L). MRI Brain lumbar puncture revealed acute abnormality. Meningitis panel consisting E.coli, H.influenzae, Listeria monocytogene, N. meningitidis, Strep pneumoniae agalactiae, Cytomegalovirus, Herpes simplex 1 2, Varicella zoster virus, Enterovirus C.neo non detectable. CSF gram stain organisms. Staining acid fast bacilli PCR west nile virus Lyme were negative. Autoimmune encephalitis came back positive NMDA which IV steroids IVIG. DISCUSSION: The characteristic picture can be divided 3 phases: I respiratory symptoms mild fever, II psychiatric manifestations III development neurological symptoms.[5] Psychiatric consist delusions, hallucinations, anxiety mania while includes movement disorder, autonomic instability, central hypoventilation coma.[3,5] difficult differentiate from primary disorder if patient presents symptoms. Early suspicion diagnosis are key start treatment form immunotherapy or removal tumor.[6] CONCLUSIONS: differential must young neuropsychiatric they often misdiagnosed disorders, impedes early treatment.The tumor generally carry good prognosis complete recovery. REFERENCE #1: Engen K, Agartz I. Anti-NMDA-reseptorencefalitt [Anti-NMDA-receptor encephalitis]. Tidsskr Nor Laegeforen. 2016 Jun 21;136(11):1006-9. Norwegian. doi: 10.4045/tidsskr.15.0795. PMID: 27325034. #2: Josep Dalmau, Thais Armangué, Jesús Planagumà, Marija Radosevic, Francesco Mannara, Frank Leypoldt, Christian Geis, Eric Lancaster, Maarten J Titulaer, Myrna R Rosenfeld, Francesc Graus, An update anti-NMDA neurologists psychiatrists: mechanisms models, Lancet Neurology, Volume 18, Issue 11, 2019, Pages 1045-1057, ISSN 1474-4422, https://doi.org/10.1016/S1474-4422(19)30244-3. #3: Dalmau J, Gleichman AJ, Hughes EG et al. Anti-NMDA-receptor encephalitis: case series analysis effects antibodies. Neurol 2008; 7: 1091 - 8 DISCLOSURES: No relevant relationships by Devashish Desai, source=Web Response Pushti Khandwala, Goonja Patel, Rajagopalan Rengan,