Introduction :

Autoimmune encephalitis with anti N –methyl-D-aspartate (NMDA)

receptor antibodies is a recently described and currently misdiagnosed

type of encephalitis. Many patients are first seen by psychiatrists

because of the frequent onset of the disease with psychiatric

symptoms.

Observation :

we report the case of a 22 –year-old patient admitted to our

department for behavioral disorders evolving since 2 months.She has

a beta thalassemia major treated with iterative transfusions and total

splenectomy at the age of 8 and a history of recurrent septic arthritis

.Since 2 months, she had behavioral changes such as agitation,

anosognosia, hypomania alternating with periods of catatonia and

massive anxiety requiring the prescription of psychotropic medication.

Clinically, psychiatric assessment revealedauditory and visual

hallucination and irritability. Physical examination showed no

abnormalities except for hyperreflexia in four limbs. The diagnosis of

limbic encephalitis was made 2 weeks later after excluding infectious,

metabolic and toxic causes, the presence of moderate

hyperproteinorachia in the cerebro spinal fluid (CSF), normal brain MRI

imaging and anti-NMDA antibodies detection in the serum. Thoraco-

abdominal pelvic CT scan and tumor markers were unremarkable

consistently, gamma –immunoglobulin therapy dramatically improved

symptoms, which further confirmed the diagnosis.

Conclusion :

Isolated psychiatric symptoms or associated with cognitive disorders

and, epilepsy with normal brain imaging should discuss lumbar

puncture and antibody testing for autoimmune encephalitis diagnosis.

Dr. Mouna Naguazi is a dedicated healthcare professional currently affiliated with the University Hospital of Ibn Jazzar in Kairouan, Tunisia. She brings a wealth of expertise to her field, contributing to the advancement of medical care in Tunisia. Dr. Naguazi is passionate about her work and strives to make a positive impact on the lives of her patients.