# 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.

## Key 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.