Anti-NMDA receptor encephalitis
with coexisting autoimmune GFAP
astrocytopathy presenting with psychiatric
symptoms leading to a suicide attempt: a case
report

Anti-NMDA receptor encephalitis
with coexisting autoimmune GFAP
astrocytopathy presenting with psychiatric
symptoms leading to a suicide attempt: a case
report

Glial fibrillary acidic protein astrocytopathy (GFAP-A), Autoimmune encephalitis, Psychiatric symptoms,
Suicide attempt, Hyponatremia

Abstract
Background Distinguishing altered consciousness owing to an underlying organic disorder from a psychiatric
etiology can be challenging in patients presenting at the emergency department after a suicide attempt.
Case presentation The patient was a 52-year-old woman who jumped from the third floor of her house. She
sustained a small subdural hematoma in the left cerebellar tentorium and a fracture of the right first rib. She was
admitted to our tertiary emergency and critical care center for further evaluation of the head injury and remained
clinically stable. On hospital day 2, the patient was diagnosed with severe depression by a psychiatrist and was
transferred to a psychiatric ward. However, she developed disturbances of consciousness and cognitive impairment
that could not be explained by psychiatric illness thereafter. Further workup revealed anti-N-methyl-D-aspartate
receptor (anti-NMDAR) encephalitis and autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy as the
etiology. High-dose intravenous methylprednisolone therapy together with high-dose intravenous immunoglobulin
was initiated. Disturbances of consciousness and cognitive impairment did not fully recover; however, she was
transferred to another hospital on day 149.
Conclusion Apart from psychiatric causes, organic etiologies should be considered in patients who have attempted
suicide if psychiatric interventions cannot explain cognitive abnormalities. This approach facilitates timely diagnosis
and management of treatable diseases such as coexisting anti-NMDAR encephalitis and autoimmune GFAP
astrocytopathy.
Keywords Glial fibrillary acidic protein astrocytopathy (GFAP-A), Autoimmune encephalitis, Psychiatric symptoms,
Suicide attempt, Hyponatremia

Soichiro Kano1

, Ryo Kamidani1,2*, Takahito Miyake1

, Tomohide Ando3

, Yuto Tamaoki1,4, Yoya Ono3

, Masato Shiba1,5,

Akio Kimura3

, Shozo Yoshida1

, Takayoshi Shimohata3

and Hideshi Okada1,6

https://doi.org/10.1186/s12245-025-01095-9

2026

peri irawan

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