Al Futaisi Amna, Uraba Wafa Bani, Al Dhawi Naji, Al Ajmi Eiman, Al Kindi Mahmood, Al Shukaili Jalila, Al Adi Azza
Pediatric Neurology Unit, Department of Child Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.
General Pediatrics Department, Al Nahdha Hospital, Muscat, Oman.
Oman Med J. 2023 Nov 30;38(6):e578. doi: 10.5001/omj.2023.68. eCollection 2023 Nov.
Commonly, herpes simplex virus (HSV) causes infectious encephalitis among children. A neurological relapse after primary HSV encephalitis in the weeks or months after presentation is well recognized. Relapsing symptoms of post-HSV encephalitis can present either as a true relapse or an immune-mediated disorder. A relationship is predicted between immune-mediated disorder and N-methyl-D-aspartate receptor (NMDAR) antibodies. This study presents two cases of patients suffering from anti-NMDAR encephalitis that appeared after treatment for proven HSV encephalitis. The first patient was treated immediately after the presentation as autoimmune encephalitis and had an excellent outcome. The second patient had delayed initiation of treatment and suffered from intractable epilepsy and severe global developmental delay. An important role is played by recognizing anti-NMDAR encephalitis symptoms and its variable presentation for timely diagnosis and quick initiation of treatment for anti-NMDAR encephalitis, thus, improving the outcome for those patients.
通常，单纯疱疹病毒（HSV）会导致儿童感染性脑炎。原发性HSV脑炎发病数周或数月后出现神经功能复发是广为人知的。HSV脑炎后复发症状可表现为真正的复发或免疫介导性疾病。免疫介导性疾病与N-甲基-D-天冬氨酸受体（NMDAR）抗体之间存在关联。本研究报告了两例在确诊HSV脑炎治疗后出现抗NMDAR脑炎的患者。首例患者在发病后立即作为自身免疫性脑炎进行治疗，预后良好。第二例患者治疗开始延迟，患有难治性癫痫和严重的全面发育迟缓。认识抗NMDAR脑炎症状及其多变表现对于及时诊断和迅速启动抗NMDAR脑炎治疗起着重要作用，从而改善这些患者的预后。
