A 28-year-old resident of Thane, who began seeing the world as a photographic negative, developed dramatic personality changes and recurrent seizures, and eventually required ventilator support, has made a near-complete recovery after doctors diagnosed him with anti-NMDA receptor autoimmune encephalitis. This rare but potentially fatal brain disorder can masquerade as a psychiatric illness.
The disease, estimated to affect around 1.5 people per million and commonly seen in young adults, is difficult to diagnose because its early symptoms can resemble flu, movement disorders, or psychiatric conditions.
For Asif (name changed), the ordeal lasted nearly six months. Although the year began on a happy note with his wedding being fixed, he realized something was wrong on the first day of Ramzan fasting in February. After reaching his family's furnishings shop on the Thane-Bhiwandi Road, he was unable to get out of the autorickshaw because his legs had seemingly frozen.
Over the next few days, the symptoms became stranger. Asif complained that everything appeared like a “negative camera image,” with colors inverted. An eye examination found no abnormality. He also began experiencing abdominal pain and painful cramps in his legs.
When repeated visits to doctors failed to provide answers, his family consulted a psychiatrist. The anti-anxiety medication, however, changed his personality: “From being a quiet person who would spend his spare time reading the Quran, Asif started talking non-stop, hugging family members and repeatedly telling us how much he loved us,” recalled his elder brother, Mofid (name changed). By mid-April, Asif began suffering seizures, with the frequency escalating to almost one every hour within days. His condition rapidly deteriorated, and he developed altered consciousness that resulted in hospitalization requiring ventilator support.
Neurologist Dr. Nikhil Jadhav of KIMS Hospital, Thane, said, “What made the case especially challenging was that the initial investigations, including MRI brain scans and infection panels, were normal.” As Asif’s condition continued to worsen, he ordered specialized neuroimmunology tests, which confirmed anti-NMDA receptor autoimmune encephalitis. Treatment with high-dose steroids and intravenous immunoglobulin (IVIG) was started immediately.
“He required IVIG injections costing nearly Rs 3 lakh, but the response was dramatic. By the 10th day of hospitalization, he was alert and talking to us,” said Mofid. Dr. Jadhav noted that the disorder is classically seen in young women and is often associated with ovarian teratomas. “This is the first male patient with anti-NMDA receptor autoimmune encephalitis that I have personally treated. The disease can occur with or without an associated tumor,” he said.
Neurologist Dr. Sangeeta Rawat, former dean of KEM Hospital, said awareness of autoimmune encephalitis is increasing as specialized diagnostic tests become more widely available. “If not picked up in time, it can be fatal,” she said, adding that referral centers such as KEM Hospital see at least one such case every couple of months.
Dr. Pradyuman Oak of Nanavati Hospital said, “We now have several medicines to treat these neuroimmunological conditions. If picked up in time, patients can improve significantly and return to a normal quality of life.”
The disorder gained international attention through American journalist Susannah Cahalan’s memoir “Brain on Fire: My Month of Madness” about her near-fatal misdiagnosis as a psychiatric patient before doctors identified anti-NMDA receptor autoimmune encephalitis.
