Autoimmune etiologies of pediatric encephalitis are being increasingly identified and characterized. The most common to date is anti-N-methyl-D-aspartate receptor encephalitis which very commonly presents with acute or subacute neuropsychiatric symptoms including movement disorder, sleep disturbance, manic and psychotic symptoms, as well as catatonia in addition to autonomic instability and frank seizures. This condition can mimic primary psychiatric disorders, the misidentification of which can delay care. This is the case of a young man and his journey through initial symptomatology, diagnostic complexity, months of intensive complex neuropsychiatric and medical management, and then gradual, painstaking return to function by means of multimodal neuropsychiatric and therapeutic intervention. This case exemplifies the need for clinicians of a broad range of specialties to appreciate the presentation, course, management, and outcomes of this increasingly recognized condition.
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