NMDAR Encephalitis Associated With Acute Chikungunya Virus Infection: A New Trigger?

Frontiers in Pediatrics

article

Paulo Ribeiro Nóbrega¹  Norma Martins de Menezes Morais²  Pedro Braga-Neto¹  Liziana Sofia da Silva Barros³  Fernanda Paiva Pereira Honório³  Alessandra Dellavance⁵  Romana Hoftberger⁶  Lívia Almeida Dutra⁷ 

[1] Division of Neurology, Department of Clinical Medicine, Universidade Federal do Ceará;Department of Pediatrics, Unichristus Medical School;Hospital Universitário Walter Cantídio, Universidade Federal Do Ceará;Center of Health Sciences, Universidade Estadual do Ceará;Laboratório Fleury;Institute of Neurology, Medical University of Vienna;Faculdade Israelita de Ciências da Saúde Albert Einstein

关键词: autoimmune;    encephalitis;    anti-NMDAR;    Chikungunya;    Arboviral diseases;   

DOI  :  10.3389/fped.2020.00176

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background: Anti-NMDAR encephalitis is the most frequent cause of autoimmune encephalitis. Chikungunya (CHIK) is an arbovirus responsible for outbreaks of fever, cutaneous rash and arthritis in underdeveloped countries, and a trigger for autoimmunity. Case Presentation: We report a five-year-old male patient with fever, myalgia, headache and conjunctivitis for 5 days. After 1 week he developed tonic-clonic seizures and evolved with dystonia and oromandibular dyskinesia followed by onset of focal motor seizures, decreased level of consciousness, dysautonomia and central apnea. Brain MRI was normal, CSF analysis revealed 15 cells, protein 16.6 mg/dL and glucose 68 mg/dL. Anti-NMDAR antibodies were detected in serum and CSF after 3 weeks of symptom onset. CHIK serology was positive for both IgM and IgG, suggesting a recent infection. Dengue and Zika serologies were negative. CSF PCR for herpes viruses and arboviruses (CHIK, Dengue and Zika) were negative. Conclusion: We report the occurrence of anti-NMDAR encephalitis after acute CHIK infection. The biphasic course, positivity for both CHIK IgM and IgG and negative CHIK CSF PCR results, as well as a dramatic response to immunotherapy suggest an immune-mediated pathogenesis. Because of the global epidemic of CHIK infection and unknown mechanisms involving CHIK and autoimmunity, patients with acute CHIK infections and neurological manifestations should be considered for antineuronal antibody testing.

【 授权许可】

CC BY