Xiaoli Chen, Qun Wang, Jing Li, Huan Yang, Si Chen
Department of Neurology, Shaanxi Provincial People's Hospital, Xi'an, China.
Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.
Front Neurol. 2022 Jul 7;13:870607. doi: 10.3389/fneur.2022.870607. eCollection 2022.
Cases of tuberculosis triggering the development of anti--methyl--aspartate receptor (NMDAR) encephalitis are absent.
Herein, we report, for the first time, the case of a patient who developed anti-NMDAR encephalitis likely due to tuberculosis. The patient, a 33-year-old man, experienced weight loss during the previous 2 years, along with acute headache, fever, cognitive deficits, and right ophthalmoplegia. Based on these findings and on data from magnetic resonance imaging and cerebrospinal fluid antibody analysis, tuberculous meningoencephalitis combined with anti-NMDAR encephalitis was diagnosed. Marked clinical and brain imaging improvement were observed after antituberculosis and high-dose corticosteroid treatment initiation, which persisted during the 3 months of follow-up.
This case suggests that anti-NMDAR encephalitis may arise after tuberculosis infection. Therefore, clinicians must be aware of this possibility, especially when cognitive and new neurological symptoms suddenly occur.
尚无结核病引发抗N-甲基-D-天冬氨酸受体（NMDAR）脑炎的病例。
在此，我们首次报告了一例可能因结核病而发生抗NMDAR脑炎的患者。该患者为一名33岁男性，在过去2年中体重减轻，伴有急性头痛、发热、认知缺陷和右眼动眼神经麻痹。基于这些发现以及磁共振成像和脑脊液抗体分析的数据，诊断为结核性脑膜脑炎合并抗NMDAR脑炎。开始抗结核和大剂量皮质类固醇治疗后，观察到临床和脑成像有明显改善，在3个月的随访期间持续存在。
该病例提示结核病感染后可能发生抗NMDAR脑炎。因此，临床医生必须意识到这种可能性，尤其是在突然出现认知和新的神经症状时。
