Herpes simplex virus-1 encephalitis can trigger anti-NMDA receptor encephalitis: case report

Neurology. 2013 Oct 29;81(18):1637-9. doi: 10.1212/WNL.0b013e3182a9f531. Epub 2013 Oct 2.


Relapsing symptoms post herpes simplex virus 1 (HSV) encephalitis (HSVE) usually occur a few weeks after viral therapy and represent either 1) a true viral relapse of HSVE (CSF PCR positive for HSV, new necrotic lesions on brain MRI, and response to acyclovir therapy) or 2) a disorder postulated to be immune-mediated (CSF negative for HSV, no new necrotic lesions, and no response to acyclovir).1,2 It has been suggested that this immune-mediated disorder may be related to NMDA receptor (NMDAR) antibodies,3 and we recently reported a child in whom relapsing symptoms post HSVE were the presentation of anti-NMDAR encephalitis.4 We report an adult with this disorder, demonstrate that synthesis of NMDAR antibodies began after HSVE, and show that relapsing symptoms were due to steroid-responsive anti-NMDAR encephalitis.

Publication types

  • Case Reports
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis / cerebrospinal fluid
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis / etiology*
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis / virology
  • Encephalitis, Viral / cerebrospinal fluid
  • Encephalitis, Viral / complications*
  • Herpesvirus 1, Human / pathogenicity*
  • Humans
  • Male
  • Young Adult