Taib Nur Iwana Abdul, Wahab Suzaily, Khoo Ching Soong, Tan Hui Jan, Kamaruzaman Lydia, Woon Luke Sy-Cherng, Gan Lydia Lay Yen
Department of Psychological Medicine, Faculty of Medicine and Health Sciences, University Malaysia Sarawak, Kota Samarahan, Malaysia.
Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
Front Psychiatry. 2022 May 4;13:779520. doi: 10.3389/fpsyt.2022.779520. eCollection 2022.
Cotard's syndrome is uncommon psychopathology among patients with psychotic illnesses. Limited cases had been reported regarding the occurrence of this syndrome in anti-NMDAR encephalitis which itself is a relatively new disease that often presents with florid psychotic symptoms. This poses difficulties in differentiating it from a primary psychiatric illness. Late recognition of anti-NMDAR encephalitis can lead to death as it can progress to autonomic instability in its natural course of illness. We report a patient who first presented with psychotic symptoms with initial negative findings from baseline investigations. Further investigation revealed anti NMDAR antibodies in the cerebrospinal fluid. Prompt treatment was initiated and despite early poor response to the first-line treatment with the development of allergic reaction, our patient recovered completely after 1 month of hospitalization. This case report aims to highlight the importance of early detection of anti-NMDAR encephalitis and the possibility of uncommon psychopathology such as Cotard's syndrome occurring in this disease.
科塔尔综合征在患有精神疾病的患者中是一种罕见的精神病理学表现。关于该综合征在抗N-甲基-D-天冬氨酸受体（NMDAR）脑炎中发生的病例报道有限，而抗NMDAR脑炎本身是一种相对较新的疾病，常表现为明显的精神病症状。这给将其与原发性精神疾病区分开来带来了困难。抗NMDAR脑炎的延迟识别可能导致死亡，因为在其自然病程中它可能进展为自主神经功能不稳定。我们报告一名患者，最初表现为精神病症状，基线检查最初结果为阴性。进一步检查发现脑脊液中有抗NMDAR抗体。立即开始治疗，尽管一线治疗初期反应不佳且出现了过敏反应，但我们的患者住院1个月后完全康复。本病例报告旨在强调早期检测抗NMDAR脑炎的重要性，以及这种疾病中可能出现如科塔尔综合征等罕见精神病理学表现的可能性。
