AUTOIMMUNE ENCEPHALITIS, AN EASILY OVERLOOKED ENTITY

1. Background:  Behavioral problems are a growing issue in our country. Early developmental-behavior problems are common but not benign. Majority of such children present to their primary pediatrician and unless screened properly will lead to misdiagnosis and subsequent faulty management of the same. The present case emphasis how an apparent behavioral issue is just the tip of an iceberg and that we need to have high index of suspicion for other associated

pathologies which needs aggressive management.

1. Case characteristics: 8 year old male child with altered behavior, aggressiveness and loss of interest in play and other spheres of interest.  No significant physical findings. Normal antenatal, natal, development history. Unremarkable family history. Investigated for organic causes initially. After thorough evaluation, found to be positive for anti NMDA receptor antibody.

1. Final diagnosis: Autoimmune encephalitis. We gave the child IVIG and plasmapheresis. Child improved. Currently doing well

1. Conclusion: Behavioral issues can be an initial presention of a CNS pathology. Most of such children are referred to psychiatrists or interpreted in the light of stress or recent adverse family event. High index of suspicion and meticulous exclusion of other organic causes should be sought before labeling them as disorders of behavior and initiating a management based on those principles