Acute Anti-N-Methyl D-Aspartate Receptor Encephalitis Following Covid-19 Vaccination

Abstract

We present a rare case of acute anti NMDAR encephalitis after COVID - 19 vaccination (Sinopharm). On literature review only 1 such case has been reported so far. Our patient initially presented with flu like symptoms and generalized weakness which started 1 day after COVID - 19 vaccine. 3 weeks later she received second dose of vaccine which led to worsening of her symptoms including progressive cognitive decline. She eventually deteriorated and required ICU management for 2 months due to depressed level of consciousness, respiratory and hemodynamic instability requiring intubation and ventilation support. During course of disease, she had clinical features consistent with NMDA encephalitis including constitutional symptoms, memory disturbance, confusion, fish mouthing movement and seizures requiring treatment with anti - epileptic medications. Diagnosis was confirmed after CSF NMDA testing as blood NMDA test was negative. The patient was treated with high dose steroids, IVIg, TPLEX and finally Rituximab. She responded very well to the complex treatment.