Teratoma-associated anti-N-methyl-D-aspartate receptor encephalitis: A case report and literature review
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Published on: November 23, 2013
Bin Yan1,2, You Wang1,2, Ying Zhang3
1Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University.
Rationale:
Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an autoimmune disease associated with the NMDA receptor and has a good response to treatment. However, only few cases related to teratoma have been reported. Here, we report a case of teratoma-associated anti-NMDAR encephalitis.
Patient Concerns:
A 25-year-old woman presenting with fever for 20 days and psychiatric symptoms for 9 days was admitted to the hospital. The patient progressed to a minimally conscious state consistent with encephalitis.
Diagnosis:
Considering the possibility of autoantibody-mediated encephalitis, laboratory tests were conducted to detect anti-NMDAR antibodies in cerebrospinal fluid and serum. Results confirmed the diagnosis of anti-NMDAR encephalitis. Furthermore, gynecological ultrasound investigation detected teratoma in the left ovary.
Interventions:
After resection of the teratoma with laparoscopic adnexectom, the patient was treatment with immunosuppressive therapy.
Outcomes:
The patient recovered gradually and was discharged 2 months after the operation.
Lessons:
Anti-NMDAR encephalitis remains difficult to diagnose because of its vague manifestations, and no clinical practice guidelines for prevention and treatment of the disease have been established yet. The clinical data of a case of teratoma-related anti-NMDAR encephalitis were analyzed, and relevant studies were reviewed.
Insights
This case study highlights a rare instance of anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis associated with teratoma. Early diagnosis and surgical removal of the teratoma, followed by immunosuppressive therapy, led to the patient's recovery.
Area of Science:
- Neuroimmunology
- Oncology
Background:
- Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a treatable autoimmune neurological disorder.
- Teratoma-associated anti-NMDAR encephalitis is infrequently reported, necessitating further case documentation.
Observation:
- A 25-year-old woman presented with prolonged fever and psychiatric symptoms, progressing to a minimally conscious state.
- Diagnostic workup confirmed anti-NMDAR antibodies in cerebrospinal fluid and serum, alongside a left ovarian teratoma.
Findings:
- Surgical resection of the teratoma and subsequent immunosuppressive therapy resulted in gradual patient recovery.
- The patient was discharged two months post-operation, showing significant improvement.
Implications:
- This case underscores the importance of considering teratoma in the differential diagnosis of anti-NMDAR encephalitis.
- Further research and established clinical guidelines are needed for the diagnosis and management of this complex condition.
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