Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2020; 8(12): 2603-2609
Published online Jun 26, 2020. doi: 10.12998/wjcc.v8.i12.2603
Anti-N-methyl-D-aspartate-receptor antibody encephalitis combined with syphilis: A case report
Xi-Yu Li, Zhi-Hong Shi, Ya-Lin Guan, Yong Ji
Xi-Yu Li, Graduate School, Tianjin Medical College, Tianjin 300070, China
Zhi-Hong Shi, Ya-Lin Guan, Yong Ji, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin Dementia Institute, Department of Neurology, Tianjin Huanhu Hospital, Tianjin 300350, China
Yong Ji, China National Clinical Research Center for Neurological Diseases, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
Author contributions: Li XY wrote the main manuscript text; Guan YL collected the clinical data; Shi ZH and Ji Y reviewed the manuscript.
Supported by the National Natural Science Foundation of China, No. 81571057; and Tianjin Science and Technology Project, No. 16ZXMJSY00010.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Zhi-Hong Shi, MD, PhD, Chief Doctor, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin Dementia Institute, Department of Neurology, Tianjin Huanhu Hospital, No. 6, Jizhao Street, Jinnan District, Tianjin 300350, China. shzhh1204@126.com
Received: March 8, 2020
Peer-review started: March 8, 2020
First decision: April 22, 2020
Revised: May 18, 2020
Accepted: May 26, 2020
Article in press: May 26, 2020
Published online: June 26, 2020
Processing time: 107 Days and 23.6 Hours
Abstract
BACKGROUND

Anti-N-methyl-D-aspartate-receptor (NMDAR) encephalitis is a common type of autoimmune encephalitis characterized by complex clinical signs and variable imaging manifestations. The pathogenesis of the disease is unclear. Syphilis is an infectious disease caused by Treponema pallidum that can invade the nervous and immune systems and cause systemic symptoms. There are few reports of anti-NMDAR encephalitis with syphilis, and the association between them is unknown; both diseases are related to immune system damage. We report a case of anti-NMDAR encephalitis with syphilis.

CASE SUMMARY

A 32-year-old man was admitted to our hospital with complaints of cognitive decline, diplopia, and walking instability during the previous 6 mo. He developed dysarthria, difficulty swallowing, and involuntary shaking of his head, neck, and limbs during the month prior to presentation. Cranial magnetic resonance imaging showed symmetrical abnormal signals in the pons, midbrain, and bilateral basal ganglia, and inflammatory demyelination was considered. The diagnosis of syphilis was confirmed based on the syphilis diagnosis test and the syphilis rapid test. He was given anti-syphilis treatment, but the above symptoms gradually worsened. Anti-NMDAR antibody was positive in cerebrospinal fluid but was negative in serum. Due to the cerebrospinal fluid findings, anti-NMDAR encephalitis was a consideration. According to the patient’s weight, he was treated with intravenous methylprednisolone 1 g QD for 5 d, with the dose gradually decreased for 6 mo, and immunoglobulin 25 g QD for 5 d; his symptoms improved after treatment.

CONCLUSION

This case shows that anti-NMDAR encephalitis may be combined with syphilis, which should be recognized to avoid misdiagnosis and treatment delay.

Keywords: Anti-N-methyl-D-aspartate receptor encephalitis; Syphilis; Imaging manifestations; Treatment; Methylprednisolone; Immunoglobulin; Case report

Core tip: Anti-N-methyl-D-aspartate-receptor (NMDAR) encephalitis is a common type of autoimmune encephalitis characterized by complex clinical signs and various imaging manifestations. We present a rare case of anti-NMDAR encephalitis combined with syphilis, developing in a previously healthy immunocompetent male patient. Anti-NMDAR was detected in the cerebrospinal fluid. Our patient’s symptoms improved after methylprednisolone and immunoglobulin treatment. This case emphasizes that anti-NMDAR encephalitis can present in combination with syphilis. The unique imaging manifestations of anti-NMDAR encephalitis and the clinical manifestations caused by the involvement of the pons, midbrain, and basal ganglia should be recognized.