Anti-NMDAR encephalitis following malaria: expanding the spectrum of post−malarial neurological syndromes

TL;DR

This paper reports the first confirmed case of anti-NMDAR encephalitis following malaria, expanding the known neurological complications of the disease.

Contribution

The study presents the first antibody-confirmed case of anti-NMDAR encephalitis triggered by Plasmodium falciparum malaria.

Findings

Anti-NMDAR encephalitis occurred in a patient 11 days after recovering from P. falciparum malaria.

The patient showed rapid improvement after immunotherapy, with no evidence of other infections or tumors.

The case highlights the need for early antibody testing for AIE in post-malarial neuropsychiatric symptoms.

Abstract

Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is the most common form of autoimmune encephalitis (AIE), often triggered by viral infections or tumors. This report describes a rare case following a parasitic infection.

We report a rare case of anti-NMDAR encephalitis developing in a 40-year-old man following recovery from Plasmodium falciparum malaria. Despite confirmed parasite clearance, he presented eleven days later with seizures, altered consciousness, and acute psychosis. Anti-NMDAR antibodies were detected in the cerebrospinal fluid (CSF) via both immunofluorescence and cell-based assay, with no evidence of concurrent infection or malignancy. The patient showed rapid clinical improvement after first-line immunotherapy.

This report represents the first antibody-confirmed case of anti-NMDAR encephalitis following Plasmodium falciparum infection, highlighting malaria as a novel post-infectious trigger and expanding the recognized spectrum of post-malarial neurological syndromes (PMNS). It underscores that clinicians in endemic regions should maintain a high index of suspicion for AIE in patients with new neuropsychiatric symptoms after malaria and pursue early antibody testing and immunotherapy.

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