Background: Anti-NMDA receptor (NMDAR) encephalitis is an autoimmune
syndrome characterized by a well-described constellation of neuropsychiatric symptoms. Its
exact pathophysiology is poorly understood, but it is thought to be mediated by autoantibodies
against NMDA (N-methyl-D-aspartate)-type glutamate receptors in the central nervous
system. There is ongoing literature to suggest that patients with autism spectrum disorder
(ASD) have evidence of neuroinflammation—or by definition, encephalitis.
Objective: To investigate the link between autism spectrum disorder and autoimmune encephalitides.
Method: We present a case of anti-NMDA receptor encephalitis in a patient with autism
spectrum disorder. “OP” is a 16-year-old male with a history of attention-deficit/ hyperactivity
disorder (ADHD) and autism spectrum disorder (ASD) who presented with a 3-day history
of acute-onset altered mental status, electroencephalogram (EEG)-corroborated seizures,
and slurred speech. Laboratory studies were significant for serum- and cerebrospinal fluid
(CSF)-positive NMDA antibodies. The child psychiatry consult-liaison service was consulted
for significant agitation and behavioral dyscontrol. We recommended 1:1 observation
for safety, as well as antipsychotic agents titrated to clinical effect. The patient had a protracted
hospital course, but was eventually discharged to an acute rehabilitation facility for
continued stabilization and therapy.
Conclusion: It remains to be seen if the relation between encephalitis and ASD is uni- or bidirectional,
that is: whether children with ASD have a genetic diathesis to developing encephalitides
(such as those mediated by the NMDAR), or conversely, if deranged or inflamed
neuroreceptor processes are implicated in the development of ASD.