Anti-NMDA receptor encephalitis in a patient with Ankylosing Spondylitis receiving etanercept treatment

Title : Anti-NMDA receptor encephalitis in a patient with Ankylosing Spondylitis receiving etanercept treatment

Abstract:

A patient diagnosed with Ankylosing Spondylitis on long-term etanercept treatment presented in the Emergency Department with subacute progressive cognitive dysfunction and personality change. He further developed psychiatric symptoms, autonomic dysfunction and orofacial dyskinesias within the first days of admission. His serum was initially negative for autoimmune neuronal antibodies, however CSF analysis was positive for anti-N-Methyl-D-Aspartate Receptor (anti-NMDAR). During his ten-week admission, he was treated with intravenous methylprednisolone, intravenous immunoglobulins, plasma exchange and rituximab before making full recovery with minimal residual neurological deficits. He was discharged on a weaning dose of oral prednisolone, however was re-admitted two months later with pneumocystis jirovecii pneumonia and required three weeks inpatient treatment with intravenous antibiotics.  To our knowledge, this is the first report of etanercept-associated anti-NMDAR encephalitis. This case additionally highlights the importance of CSF over serum sampling in suspected anti-NMDAR encephalitis and serves as a reminder for clinicians to consider prophylaxis against pneumocystis pneumonia (PCP) when using long-term corticosteroids for neurological conditions

Biography:

Dr Christina Bitsara (MB BChir, MPhil, BSc) received her medical degree from the University of Cambridge in 2021. She also holds an MPhil in Genomics Medicine from the University of Cambridge where she conducted research at the Wellcome Sanger Institute and discovered new variants for rare neurological disorders and has a BSc in Neuroscience from Kings College London. This is her third year working as a doctor in the National Health Service in the UK. During her Foundation Years of training, she has worked both at a tertiary center at Guy’s and St Thomas’s hospital in London and at a District General Hospital at Royal Tunbridge Wells in Kent. She currently holds the position of Academic Junior Clinical Fellow in the Emergency Department where she is involved in teaching and training of junior doctors and medical students. Dr Bitsara will continue into Internal Medicine Training next year. She has a keen interest in neuro inflammatory conditions and movement disorders and will specialize in Neurology. She has also been Conference lead and President of university societies for 5 consecutive years where she organized annual Neuroscience and Neurology conferences with both national and international speakers and has also held a fundraiser for Epilepsy UK that raised £3,000.