Fever of Unknown Origin: An Unusual Presentation of Anti-N-Methyl-D-Aspartate Receptor Encephalitis

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Jian Hur1

  • 1Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea.

Infection & Chemotherapy
|July 10, 2015
PubMed

Insights

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis presents with varied symptoms, often mimicking infections. Early suspicion and treatment, especially in young women with psychiatric symptoms, are crucial for recovery.

Area of Science:

  • Neurology
  • Immunology

Background:

  • Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis exhibits diverse clinical presentations, frequently misdiagnosed as infectious or psychiatric disorders.
  • Prodromal symptoms like fever, headache, and gastrointestinal issues, alongside autonomic dysfunction, are common in NMDAR encephalitis.
  • Ovarian teratomas are a significant underlying cause, particularly in young women.

Purpose of the Study:

  • To highlight the variable clinical manifestations of anti-NMDAR encephalitis.
  • To emphasize the importance of considering anti-NMDAR encephalitis in patients with unexplained psychiatric symptoms and fever.
  • To report a case of anti-NMDAR encephalitis associated with an ovarian teratoma.

Main Methods:

  • Case report of a 36-year-old woman with psychiatric symptoms and fever.
  • Diagnostic workup included cerebrospinal fluid (CSF) and serum antibody testing for NMDAR.
  • Pelvic computed tomography (CT) was used to identify potential tumors.

Main Results:

  • The patient presented with uncontrolled fever, skin infections, psychiatric symptoms, and abnormal behavior, initially diagnosed as bipolar disorder.
  • NMDAR antibodies were detected in CSF and serum.
  • A large ovarian teratoma was identified via pelvic CT.

Conclusions:

  • Prompt recognition and treatment of anti-NMDAR encephalitis are vital for patient outcomes.
  • Surgical removal of the teratoma and corticosteroid therapy led to dramatic improvement.
  • Physicians should maintain a high index of suspicion for anti-NMDAR encephalitis in young women with unexplained fever and acute psychiatric disturbances.
Keywords:
Anti-N-methyl-D-aspartate receptor encephalitisDermoid cystFever of unknown origin

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