A Challenging Case of Treatment-Resistant Autoimmune N-methyl-D-aspartate Receptor Encephalitis Induced Delirium

A 19-year-old African-American male was brought by his family to the emer-gency department because of altered mental status. Symptoms began with headache and forgetfulness, which pro-gressed to the inability to form complete sentences. His baseline consisted of playing video games regularly with the knowledge level of a high school graduate with honors. The patient’s family denied any history of drug or ethanol use. Negative test results, resistance to treatment, and the time tak-en to retrieve results of an autoimmune panel made the case difficult to diag-nose and treat accordingly.