PMID- 31096528 OWN - NLM STAT- MEDLINE DCOM- 20190529 LR - 20231011 IS - 1536-5964 (Electronic) IS - 0025-7974 (Print) IS - 0025-7974 (Linking) VI - 98 IP - 20 DP - 2019 May TI - Anti-N-methyl-D-aspartate receptor encephalitis associated with reactivated Epstein-Barr virus infection in pediatric patients: Three case reports. PG - e15726 LID - 10.1097/MD.0000000000015726 [doi] LID - e15726 AB - RATIONALE: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is the most frequent autoimmune encephalitis in children, and its presentation is various. The disease can be triggered by various infections. PATIENT CONCERNS: Case 1 was a 7-year-old female with the presentation of seizure, repeated fever, language disorder, and decreased muscle strength of the right limbs; Case 2 was a 7-year-old male with the manifestation of repeated emesis, headache, involuntary movement, altered personality, seizures, and cognitive impairment; Case 3 was a 2-year-old female with repeated fever, emesis, seizures, coma, and decreased muscle strength of limbs. Anti-NMDAR antibody was identified in cerebrospinal fluid (CSF) in the 3 cases, confirming the diagnosis of anti-NMDAR encephalitis. Pathogenic examinations revealed positive serum Epstein-Barr virus (EBV)-nuclear antigen and EBV-capsid antigen (CA)-IgG antibodies in the 3 cases, as well as positive EBV-early antigen (EA)-IgG antibody in CSF. Case 1 also had positive EBV-CA-IgA antibody; Case 3 also had positive EBV-CA-IgA and EBV-CA-IgG antibodies. DIAGNOSES: Anti-NMDAR antibody and EBV-EA-IgG antibody in CSF were tested positive in the 3 cases. Thus, they were diagnosed as anti-NMDAR encephalitis associated with reactivated EBV infection. INTERVENTIONS: All of the 3 cases received immunoglobulin, corticosteroid, and ganciclovir treatment. Cases 2 and 3 also received antiepileptic drugs due to repeated seizures. In addition, Case 3 also received assistant respiration, plasma exchange, and rituximab. OUTCOMES: The 3 cases were substantially recovered after treatment. Repeat CSF analysis showed decreased titer of the anti-NMDAR antibody. LESSONS: Reactivated EBV infection may trigger anti-NMDAR encephalitis in children, which has not been reported previously. Related possible virology tests should be completed while diagnosing the disease. FAU - Hou, Ruolin AU - Hou R AD - Department of Pediatric Neurology, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China. FAU - Wu, Jing AU - Wu J FAU - He, Dake AU - He D FAU - Yan, Yumei AU - Yan Y FAU - Li, Ling AU - Li L LA - eng PT - Case Reports PT - Journal Article PL - United States TA - Medicine (Baltimore) JT - Medicine JID - 2985248R RN - 0 (Adrenal Cortex Hormones) RN - 0 (Anticonvulsants) RN - 0 (Autoantibodies) RN - 0 (Capsid Proteins) RN - 0 (Epstein-Barr Virus Nuclear Antigens) RN - 0 (Immunoglobulins) RN - P9G3CKZ4P5 (Ganciclovir) SB - IM MH - Adrenal Cortex Hormones/therapeutic use MH - Anti-N-Methyl-D-Aspartate Receptor Encephalitis/cerebrospinal fluid/*drug therapy/*virology MH - Anticonvulsants/therapeutic use MH - Autoantibodies/cerebrospinal fluid MH - Capsid Proteins/immunology MH - Child MH - Child, Preschool MH - Epstein-Barr Virus Infections/cerebrospinal fluid/complications/*diagnosis/*drug therapy MH - Epstein-Barr Virus Nuclear Antigens/immunology MH - Female MH - Ganciclovir/therapeutic use MH - Humans MH - Immunoglobulins/therapeutic use MH - Male MH - Seizures/cerebrospinal fluid/*drug therapy/etiology MH - Treatment Outcome PMC - PMC6531087 COIS- The authors have no conflicts of interest to disclose. EDAT- 2019/05/18 06:00 MHDA- 2019/05/30 06:00 PMCR- 2019/05/17 CRDT- 2019/05/18 06:00 PHST- 2019/05/18 06:00 [entrez] PHST- 2019/05/18 06:00 [pubmed] PHST- 2019/05/30 06:00 [medline] PHST- 2019/05/17 00:00 [pmc-release] AID - 00005792-201905170-00099 [pii] AID - MD-D-18-08812 [pii] AID - 10.1097/MD.0000000000015726 [doi] PST - ppublish SO - Medicine (Baltimore). 2019 May;98(20):e15726. doi: 10.1097/MD.0000000000015726.