An adolescent patient with anti-N-methyl-D-aspartate receptor encephalitis with motor aphasia as the first symptom and complicated by peripheral nerve damage: A case report and literature review.

RATIONALE

Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a type of autoimmune encephalitis, and the common first symptoms are mental disorders, seizures, and rarely aphasia in patients. Meanwhile, movement disorders associated with anti-NMDAR encephalitis are usually chorea and dystonia, with peripheral nerve damage being rare.

PATIENT CONCERNS

We present a case of anti-NMDAR encephalitis with motor aphasia as the first symptom. The patient, a 16-year-old female, was admitted to the hospital with further progression of the disease, complicated by grand mal seizures with peripheral nerve damage.

DIAGNOSES

Anti-NMDAR encephalitis.

INTERVENTIONS

The patient accepted first-line therapy, including methylprednisolone and intravenous immunoglobulin shock therapy, rituximab second-line treatment (rituximab), and third-line therapies (mycophenolate mofetil), as well as efgartigimod as an additional therapy.

OUTCOMES

After 6 weeks of comprehensive treatment, the patient's muscle strength in both lower limbs recovered, and the psychiatric symptoms and seizures improved.

LESSONS

This case broadens the range of clinical symptoms of anti-NMDAR encephalitis, and we should recognize that motor aphasia may also be one of the first symptoms in adolescent patients with anti-NMDAR encephalitis. What's more, efgartigimod may be a promising treatment for patients with anti-NMDAR encephalitis.