Authors: Tue Bui Chau , An Nguyen Thanh , Loc Le Quang , Thang Huynh Xuan , Lap Dinh Van

Abstract

Anti-NMDA receptor encephalitis is a severe autoimmune encephalitis characterized by progressive neuropsychiatric symptoms and the presence of Immunoglobulin G antibodies against the GluN1 subunit of NMDA receptors. We report a case of a previously healthy 20-year old woman who developed memory impairment, seizures, and progressive decline in consciousness shortly after first-trimester pregnancy termination. Initial cerebrospinal fluid (CSF) findings showed marked neutrophilic pleocytosis, mimicking bacterial meningitis, leading to delayed diagnosis. Anti-NMDAR antibodies were subsequently detected in the CSF, confirming the diagnosis. The patient required intensive care management, including mechanical ventilation and treatment of refractory status epilepticus. First-line therapy with high-dose corticosteroids and intravenous immunoglobulin resulted in partial improvement, followed by significant recovery after rituximab administration. This case highlights diagnostic challenges related to atypical CSF patterns and suggests that pregnancy termination may represent a temporal association with disease progression in susceptible individuals. Clinicians should consider autoimmune encephalitis in acute neuropsychiatric presentations following abortion.

Keywords: Anti-NMDAR encephalitis, autoimmune encephalitis, post-abortum complications, immunotherapy, case report.