An 18-year-old white female from Australasia had persistently dilated pupils in both eyes, causing discomfort and burning in sunlight, though her pupillary light reflex remained normal. She used psychedelic substances including LSD, NBOMe, psilocybin, and DMT. Extensive medical, neurological, and radiological exams—including EEG and MRI of the head and neck—found no physical or anatomical cause. She had chronic endogenous depression and attention deficit hyperactivity disorder, treated with citalopram and Ritalin. No family history of similar conditions existed.
A 15-year-old boy with sudden seizures and worsening psychiatric symptoms—including reduced reactivity, language deterioration, and catatonia—was initially misdiagnosed with a psychiatric disorder because repeated MRI scans were normal. Using autoimmune psychosis criteria, doctors suspected autoimmune encephalitis, which was confirmed by detecting oligoclonal bands and anti-NMDAR antibodies in blood and spinal fluid. Steroid pulse therapy led to significant improvement. The case shows that anti-NMDAR encephalitis can mimic primary psychiatric conditions and that autoimmune psychosis criteria, which consider features like subacute onset, catatonia, cognitive dysfunction, altered consciousness, and seizures, can aid diagnosis even when standard biomarkers are negative.