Mania with malignant catatonia due to nonparaneoplstic anti-n-methyl-d-aspartate receptors encephalitis in a 29-year-old female: A rare entity

Abstract

Anti-N-methyl-D-aspartate receptors (NMDARs) encephalitis is a rare neurological autoimmune encephalitis. Its symptoms may mimic psychosis as this disease is a neurological disorder in psychiatry costume. Disparity in clinical symptoms and nonsupportive laboratory investigations except the cerebrospinal fluid (CSF) analysis delays the diagnosis. We are presented with a case of 29-year-old female with psychiatric symptoms such as suspiciousness, decreased sleep, and boastfulness. Within a few days, the patient developed neurological symptoms such as seizures and disorientation, while the patient was on an antipsychotic along with benzodiazepines. Her symptoms worsened with autonomic instability, and the patient entered into catatonic phase of the illness. We reached a positive diagnosis of anti-NMDAR encephalitis through CSF analysis. The patient recovered completely with the help of immunotherapy and intensive cognitive rehabilitation. This case emphasizes the need of a multidisciplinary approach in the management, early detection, and adequate treatment of this challenging illness for better results for patients.