Abstract:

Objective To analyze the clinical presentations and diagnostic and treatment process of one patient with autoimmune encephalitis（AE） with double positive anti-N-methyl-D-aspartate receptor （NMDAR） and anti-γ-aminobutyric acid B receptor （GABA_BR） secondary to herpes simplex virus encephalitis（HSVE），and to improve the clinicians’ awareness of this disease. Methods The clinical data of one AE patient with double positive anti-NMDAR and anti-GABA_BR secondary to HSVE were collected， the diagnostic and therapeutic processes were summarized， and the relevant literatures were reviewed. Results The patient， a 36-year-old male， developed a headache followed by limb convulsions， and progressed to disturbed consciousness. After admission， the routine biochemistry of the cerebrospinal fluid （CSF） was abnormal， and the herpes simplex virus-1 （HSV-1） IgG antibody showed positive in the CSF； both CSF and serum tests for NMDAR antibodies were positive； the head magnetic resonance imaging （MRI） results showed abnormal signals in the right occipital white matter， leading to the diagnosis of HSVE secondary to anti-NMDAR encephalitis. Several months later， the patient experienced psychiatric behavior abnormalities， cognitive dysfunction， and sleep disorders， and both the serum NMDAR and GABA_BR antibodies showed positive results， prompting the diagnosis of HSVE secondary anti-NMDAR encephalitis and anti-GABA_BR encephalitis. After treatment with steroid pulse therapy and intravenous immunoglobulin （IVIG）， the patient’s condition was improved and the patient was discharged. At one-year follow-up， the patient’s psychiatric symptoms had completely resolved， leaving mild cognitive impairment. Conclusion If the clinical symptoms of the patients recovering from antiviral treatment for HSVE is worsened， secondary AE should be highly suspected；it is important to complete autoimmunity antibody testing as soon as possible for the early diagnosis and treatment to improve the prognosis of the patient.

Key words: Herpes simplex virus encephalitis, Anti-N-methy-D-aspartate receptor antibody, Anti-γ-aminobutyric acid B receptor antibody, Autoimmune encephalitis