Background: Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is the most common autoimmune encephalitis reported globally. Diagnosis of this condition is often rare in low- and middle-income countries due to unavailability and costs of the immunological tests. Case presentation: We report the case of a 12-year-old male admitted to the paediatric neurology unit following the onset of acute confusion and abnormal behaviors. This was preceded by a history of afebrile focal clonic seizures 2 weeks before the onset of the confusion. He later developed facial dyskinesia, motor and cognitive regression with subsequent deterioration of the level of consciousness which necessitated intubation with ventilatory support. He was screened for acute infectious conditions common in Tanzania, Malaria, Meningitis, Tuberculosis and HIV which were all negative. The Cerebrospinal fluid assessment (CSF) showed elevated protein 8g/dl with a normal cell count. The serum and CSF auto-antibody screen showed NMDA-R Antibody positive, AMPA GLUR1 and 2 negative, CASPR negative, LGTIR negative and GABA-B rec negative. The Brain MRI was normal and the EEG at presentation were normal. He received sequential treatment of immune suppression, Intravenous Immunoglobulin and Methyl prednisolone with slight improvement of his symptoms. He subsequently received Plasmapheresis and four cycles of Rituximab. The patient’s condition subsequently improved currently 4 months after presentation is fully ambulant and speaking in short sentences. He continues with his rehabilitation. Conclusions: Anti-NMDAR can be managed with a favorable outcome in low-and-middle income countries with early clinical suspicion and availability of resources.

VICTORIA NDEMBO
MUHIMBILI NATIONAL HOSPITAL
Tanzania

OBREY URIO
MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES
Tanzania

DAVID KOMBO
MUHIMBILI NATIONAL HOSPITAL
Tanzania

AIKA SHOO
MUHIMBILI NATIONAL HOSPITAL
Tanzania

FADHILA TEKKA
MUHIMBILI NATIONAL HOSPITAL
Tanzania

ZAMEER FAKIH
MUHIMBILI NATIONAL HOSPITAL
Tanzania

ANNA MSAFIRI
MUHIMBILI NATIONAL HOSPITAL
Tanzania

KARIM DEMBE
MUHIMBILI NATIONAL HOSPITAL
Tanzania

EDWARD KIJA
MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES
Tanzania