Pulmonary embolism complicated the course of anti-N-methyl-D aspartate receptor encephalitis in a pediatric intensive care unit setting: a case report

ABSTRACT

Introduction

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, an autoimmune neurological disorder resultant from the autoantibodies directed to the NR1 subunit of the NMDAR, is mainly characterized by neuropsychiatric symptoms, including behavior changes, paranoia, delusions, epileptic seizures, movement disorders, aphasia, insomnia, dysautonomia, and altered consciousness. Pulmonary embolism (PE) presents with pleuritic chest pain, hemoptysis, and respiratory distress by obstruction of the pulmonary circulation. Unlike adults, pediatric PE usually related to obvious risk factors, including central venous line, malignancy, lupus erythematosus, renal disease, congenital thrombophilia, surgery, and major trauma. Besides, PE has rarely been encountered in adult patients with anti-NMDAR encephalitis even in the absence of these risk factors.

Case presentation

A 16-year-old male patient, with acute psychosis, epileptic seizure, and altered consciousness, was diagnosed as having anti-NMDAR encephalitis and treated by intravenous immunoglobulin and high-dose pulse intravenous methylprednisolone. During follow-up, on the 11^th day of hospitalization, the disease course was complicated by the occurrence of pulmonary embolism, presenting with acute onset respiratory distress and the need for supplementary oxygen treatment. PE improved with low-molecular-weight heparin treatment.

Conclusion

Pulmonary embolism should be kept in mind as a possible cause of respiratory insufficiency in pediatric anti-NMDAR encephalitis patients along with altered consciousness, breathing instability, hypersalivation, status epilepticus or dystonia, and their treatment.

KEYWORDS:

• Anti-N-methyl-D-aspartate receptor
• anti-NMDAR encephalitis
• autoimmune
• pediatric
• pulmonary embolism

Acknowledgments

The authors declare no acknowledgments.

Authors’ contributions

FE, DY, OOH, AY, and GGM treated the patient and were responsible for the concept, design, and acquisition of data. FE wrote the first draft of the manuscript, and DY and GGM revised and edited the manuscript. OOH and AY collected the data and were responsible for literature search. All authors read and approved the final version of the manuscript.

Declaration of interest

The authors declare that they have no competing interests.

Consent

Written informed consent was obtained from the patient for publication of this case report and any accompanying images.

Ethical standard

We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. All authors approved the final article.

Declaration of interest

The contents of the paper and the opinions expressed within are those of the authors, and it was the decision of the authors to submit the manuscript for publication.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

No funding was received.