VIÊM NÃO TỰ MIỄN DO KHÁNG THỂ KHÁNG THỤ THỂ NMDA KHỞI PHÁT SAU THỦY ĐẬU Ở TRẺ EM: BÁO CÁO MỘT CA BỆNH

Abstract

Objective: To describe the clinical presentation, investigations, treatment, and outcome of a pediatric case of anti-NMDA receptor encephalitis following primary varicella infection. Methods: Case report. Results: An 8-year-old previously healthy boy developed headache, incoherent speech, emotional lability, and behavioral disturbances two weeks after recovering from typical varicella (chickenpox). There was no fever or seizure. Brain magnetic resonance imaging with contrast showed no abnormalities. Electroencephalography revealed background slowing with the presence of delta brush patterns. Cerebrospinal fluid analysis showed mild pleocytosis, and indirect immunofluorescence detected positive anti-NMDA receptor antibodies in the cerebrospinal fluid. Serum testing revealed strongly positive IgM and IgG of Varicella Zoster virus. The patient was diagnosed with anti-NMDA receptor encephalitis and treated with intravenous Methylprednisolone and six sessions of plasma exchange. Clinical improvement was observed, particularly in communication and behavioral symptoms. The CASE (Clinical Assessment Scale in Autoimmune Encephalitis) score decreased from 9 at admission to 5 at discharge. Conclusion: This case highlights a rare but possible association between primary varicella infection and the onset of anti-NMDAR encephalitis in children. Primary Varicella Zoster virus infection may act as an immunologic trigger for autoimmune encephalitis, even in otherwise healthy pediatric patients.