Encefalitis autoinmune por anticuerpos NMDA a propósito de un caso clínico

espanolLas encefalitis autoinmune derivan de la inflamacion o disfuncion de algunas partes del cerebro causada por anticuerpos contra antigenos cerebrales especificos, y que generalmente tienen una presentacion clinica con sintomatologia psiquia-trica que muchas veces complica el diagnostico oportuno para poder dar inicio a terapias inmunosupresoras.La encefalitis por anticuerpos anti NMDARes masfrecuente en casos de ninos y adultos jovenes, y se caracterizar por la presencia suba-gudade trastornospsiquiatricos, alteracion de la conciencia, crisis epileptica, entre otros (Erazo, 2019). En el presente in-forme se describe un caso de encefalitis autoinmune anti-receptor NMDA en adulto masculino de 31 anos, con un cuadro caracterizado por trastorno del nivel de conscienciaconfundiendo las primeras impresiones diagnosticas donde es inicial-mente asistido. Despues de 15 dias de presentacion del cuadro clinico, finalmente es tratado en el Hospital Clinica Alcivar en Guayaquil, donde es ingresado a UCI requiriendo ventilacion mecanica y plasmaferesis como parte del tratamiento que involucraba varios anticomiciales, y que despues de casi dos meses de atencion intensiva, sufre una crisis tonico clonica generalizadamultiplerefractaria al tratamiento, por lo que se le induce a un coma barbiturico, y se incluye Rituximabcomo nuevo tratamiento inmunosupresor . PALABRAS CLAVES: Encefalitis, Encefalitis Autoinmune, Encefalitis anti-NMDAR. EnglishAutoimmune encephalitis derives from the inflammation or dysfunction of some parts of the brain caused by antibodies against specific brain antigens, and which generally have a clinical presentation with psychiatric symptoms that often com-plicate the timely diagnosis to be able to start immunosuppressive therapies. Anti-NMDAR antibody encephalitis is more common in children and young adults, and is characterized by the subacute presence of psychiatric disorders, altered consciousness, and epileptic seizures, among others (Erazo, 2019). This report describes a case of anti-NMDA receptor autoimmune encephalitis in a 31-year-old male adult, with a condition characterized by a disorder of the level of conscious-ness, confusing the first diagnostic impressions where it was initially attended. After 15 days of presentation of the clinical picture, he is finally treated at the Hospital ClinicaAlcivar in Guayaquil, where he is admitted to the ICU requiring mechani-cal ventilation and plasmapheresis as part of the treatment that involved several anticonvulsants, and that after almost two months of intensive care , suffers a multiple generalized tonic clonic crisis refractory to treatment, for which he is induced to a barbiturate coma, and Rituximab is included as a new immunosuppressive treatment.