Cai Xiaotang, Zhou Hui, Xie Yongmei, Yu Dan, Wang Zhiling, Ren Haitao
Department of Pediatrics, West China Second University Hospital Key Laboratory of Obstetric and Gynaecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, Sichuan Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Medicine (Baltimore). 2018 Feb;97(7):e9924. doi: 10.1097/MD.0000000000009924.
Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis has been recognized as the most frequent autoimmune encephalitis in children. Several infectious agents have been implicated in anti-NMDA encephalitis.
A previously healthy immunocompetent 9-year-old girl first presented with seizures, headaches and vomiting. Cerebrospinal fluid and brain magnetic resonance imaging were normal. After one week onset, the patient gradually developed unexplained personality and behavior changes, accompanied by fever and seizures again. Repeated CSF analysis revealed a slightly lymphocytic predominant pleocytosis and positive anti-NMDAR antibody. A variety of pathogenic examinations were negative, except for positive toxoplasma IgM and IgG.
The patient was diagnoses for anti-NMDA encephalitis associated with acute acquired toxoplasma gondii infection.
The patient received 10 days azithromycin for treatment of acquired toxoplasma infection. The parents refuse immunotherapy because substantial recovery from clinical symptoms.
The patient was substantially recovered with residual mild agitation after therapy for acquired toxoplasma gondii infection. Two months later, the patient was completely devoid of symptoms, and the levels of serum IgM and IgG of toxoplasma gondii were decreased.
Acquired toxoplasma gondii infection may trigger anti-NMDAR encephalitis in children, which has not been reported previously. Clinicians should assess the possibility of toxoplasma gondii infection when evaluating a patient with anti-NMDA encephalitis.
抗N-甲基-D-天冬氨酸受体（NMDAR）脑炎已被公认为儿童中最常见的自身免疫性脑炎。几种感染因子与抗NMDA脑炎有关。
一名先前健康、免疫功能正常的9岁女孩最初出现癫痫发作、头痛和呕吐。脑脊液和脑磁共振成像均正常。发病一周后，患者逐渐出现不明原因的性格和行为改变，并再次伴有发热和癫痫发作。重复的脑脊液分析显示以淋巴细胞为主的轻度细胞增多，抗NMDAR抗体呈阳性。除弓形虫IgM和IgG阳性外，各种病原体检查均为阴性。
该患者被诊断为与急性获得性弓形虫感染相关的抗NMDA脑炎。
患者接受了10天的阿奇霉素治疗以治疗获得性弓形虫感染。由于临床症状已大幅恢复，父母拒绝免疫治疗。
在接受获得性弓形虫感染治疗后，患者基本康复，但仍有轻度躁动。两个月后，患者完全没有症状，弓形虫的血清IgM和IgG水平下降。
获得性弓形虫感染可能会引发儿童抗NMDAR脑炎，这在以前尚未有报道。临床医生在评估抗NMDA脑炎患者时应评估弓形虫感染的可能性。
