Anti-N-Methyl-D-Aspartate Receptor (Anti-NMDAR) Encephalitis in a Young Pregnant Woman With a 10-Year Follow-Up: A Case Report

Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an autoimmune disease of the central nervous system with unknown etiology and multiple triggers. It is clinically characterized by the onset of psychiatric symptoms, seizures, memory disturbance, and cognitive decline. We present a young, newly married woman in the first trimester of pregnancy who presented with purely psychiatric manifestations, fever, and two instances of generalized tonic-clonic seizures. She eventually progressed to develop a decreased level of consciousness and hemodynamic instability. A diagnosis was made of anti-NMDA encephalitis. Her symptoms progressed even after the administration of two intravenous immunoglobulin (IVIG) trials, steroids, and three anti-seizure medications until she experienced a spontaneous abortion. She then gradually returned to her normal baseline condition. This case underscores the importance of suspecting anti-NMDAR encephalitis in pregnant patients with acute onset of psychiatric manifestations. Anti-NMDAR encephalitis can be a difficult, challenging, and exhausting diagnosis for both the patient and treating physicians, particularly in pregnant patients where diagnostic and therapeutic options may be limited due to concerns for fetal safety. However, this case provides evidence that anti-NMDAR encephalitis during pregnancy can have a good prognosis.