Infections are increasingly recognized as a common trigger of autoimmune disease, including autoimmune encephalitis. A significant association is particularly shown between HSV-1 encephalitis (HSVE) and a post-infectious autoimmune encephalitis mediated by neuronal autoantibodies, most notably anti-N-methyl-D-aspartate receptor (NMDAR) antibodies. The clinical significance of these and other novel post-infectious autoantibodies has led to new diagnostic and treatment challenges for clinicians. Here we present a case of a 19-year-old female with premorbid psychiatric disease and neuropsychiatric sequelae from HSVE who presented over a year after her initial HSVE with behavioral changes and positive anti-NMDAR antibodies. The clinical challenges encountered during this case are explored in detail based on a review of the literature. Research is needed to help guide management in these complex clinical situations.
Keywords: autoimmune diseases of the nervous system; central nervous system infections; central nervous system viral diseases; clinical specialty; encephalitis; neuroimmunology.
© The Author(s) 2020.