Rapid onset of altered mental status with progressive autonomic instability and hypoventilation in a 2-year-old male

Anti N-methyl-D-aspartate receptor (NMDAR) encephalitis should besuspected in children who report with acute behavioral change, seizures,and non-specific movement disorders. While historically associated withadolescent females with ovarian teratoma, anti-NMDAR encephalitis hasnow been described in the pediatric population of both sexes. These patientsdisplay the neurological and psychiatric manifestations similar to femalesbut lack a tumor. We report a two-year-old previously healthy young malewho presented with alteration in speech, seizures, and extra pyramidalmovement disorders. He was diagnosed with anti-NMDAR encephalitis withpositive cerebrospinal fluid (CSF) serology for anti-NMDAR antibodies.In this case report, we describe the clinical presentation, course of illness,investigation, and management of our patient. We conclude by emphasizingthree observations and insights from our case compared to what is mentionedin the literature.

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