SHM Converge Scientific Abstract ePoster Gallery-Self-Stabbing and Demyelination Secondary to Anti-Nmda-Receptor Encephalitis

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This case describes a 33-year-old woman with no psychiatric or medical history who presented after self-inflicted stab wounds to the neck and abdomen. She was unable to provide a history and appeared psychotic, minimally interactive, and intermittently rigid with episodes of tachycardia and hypertension, consistent with malignant catatonia.<br /><br />Brain MRI showed a T2/FLAIR hyperintense right parietal lesion. MR spectroscopy suggested the lesion was demyelinating rather than neoplastic. Cerebrospinal fluid studies revealed mild lymphocytic pleocytosis, elevated opening pressure, oligoclonal bands, and strongly positive NMDA receptor antibodies. Serum testing was positive for low-titer MOG antibodies. Overall, the findings suggested overlap between anti-NMDA receptor encephalitis and tumefactive multiple sclerosis.<br /><br />Her catatonia improved with lorazepam. High-dose methylprednisolone produced minimal benefit, but after five sessions of plasma exchange she became conversational, though still delirious. Follow-up MRI showed shrinkage of the brain lesion. After two rituximab infusions given two weeks apart, she improved significantly.<br /><br />The authors emphasize that neuroinflammatory disorders can overlap clinically and diagnostically. In this patient, the presentation was most consistent with anti-NMDA receptor encephalitis, while the imaging and CSF findings also supported tumefactive demyelination/MS. Low-titer MOG antibody positivity alone was not felt to support MOG-associated disease. Concurrent anti-NMDA receptor encephalitis and demyelinating disease is rare, but may reflect a shared autoimmune process.<br /><br />The case highlights that rituximab may be useful when multiple autoimmune diagnoses are possible, and that tumefactive brain lesions should be reimaged after treatment to confirm resolution and avoid misdiagnosing malignancy.

Asset Subtitle

Abhi Kole

Meta Tag

Author List Abhi Kole, Eleni Antzoulatos, Karman Duchon, Mary Ann K. Hall, Srinija Konduru

Category Clinical Vignettes

Concept Anti-NMDA Receptor Encephalitis

Concept Tumefactive Demyelinating Disease

Concept Psychosis

Concept Catatonia

Concept High-Dose Steroids

Distinguished Non-Finalist

Presenter Organization Emory University

Presenting Author Abhi Kole

Track Adult

Keywords

anti-NMDA receptor encephalitis

tumefactive multiple sclerosis

malignant catatonia

MOG antibodies

demyelinating brain lesion

plasma exchange

rituximab

cerebrospinal fluid oligoclonal bands

psychosis

autoimmune encephalitis

Anti-NMDA Receptor Encephalitis

Tumefactive Demyelinating Disease

Psychosis

Catatonia

High-Dose Steroids