Anti-N-Methyl D-aspartate receptor (anti-NMDA-R) encephalitis is an underdiagnosed autoimmune condition that can present with “flu” like illness that progresses through stages of psychotic symptoms and movement disorders that further deteriorates to autonomic instability and even death if not treated promptly. The case condition often presents to psychiatrists who may find the condition not responding to standard treatments posing significant diagnostic challenges. Often it can present as a paraneoplastic syndrome, but recent data shows the occurrence of idiopathic presentations. Here we present of a 40-year-old male with one such typical clinical presentation of psychotic symptoms along with movement abnormalities and progression to further neurological deterioration who after systemic evaluation was diagnosed to be a case of anti-NMDA-R encephalitis. He responded well to IVIG and plasma exchange. There is a need to recognize this condition more vigilantly in practice and the factors favoring prognosis and outcomes are further discussed.
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