Reversible splenial lesion syndrome (RESLES) is a transient neuroimaging finding associated with various etiologies.Although RESLES has been reported in diverse conditions, including medications, metabolic disorders, and infections, its occurrence in autoimmune encephalitis, such as anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, is rarely described.This report details a rare case demonstrating this association.A 24-year-old woman presented with a 4-month history of progressive behavioral changes, which culminated in paranoid delusions and catatonic symptoms.The initial diagnosis was delusional disorder, but her condition rapidly worsened with fever.A brain magnetic resonance imaging (MRI) revealed a reversible lesion in the splenium of the corpus callosum (SCC).Laboratory tests confirmed the presence of anti-NMDAR antibodies in her cerebrospinal fluid, and an abdominal computed tomography scan revealed bilateral ovarian teratomas.She was treated with high-dose corticosteroids and intravenous immunoglobulin, followed by surgical removal of the teratomas.Rituximab was later administered for long-term immunomodulation.The patient's clinical state, including her psychiatric and neurocognitive symptoms, gradually improved significantly.A follow-up MRI 2 months after discharge confirmed complete resolution of the SCC lesion.This case highlights that RESLES can be the initial neuroimaging manifestation of anti-NMDAR encephalitis.It underscores the critical importance of considering autoimmune causes of acute-onset psychiatric symptoms and atypical neuroimaging findings.Early and appropriate diagnosis and treatment of the underlying autoimmune etiology are essential for favorable neurological and psychiatric outcomes.
Choi et al. (Thu,) studied this question.