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Paraneoplastic anti-NMDA receptor encephalitis in 1830?
Dalma Tényi1, Anna Szűcs1, Norbert Kovács1
1From the Department of Neurology (D.T., N.K., J.J.), University of Pécs, Medical School, Hungary; National Institute of Clinical Neuroscience (A.S.), Budapest, Hungary; MTA-PTE Clinical Neuroscience MRI Research Group (N.K., J.J.), Hungary; Department of Neurology (Z.I.), Odense University Hospital, Denmark; and Department of Clinical Research (Z.I.), University of Southern Denmark, Odense.
Objective:
Our aim was to identify patients with probable anti-NMDA receptor encephalitis among historical medical cases.
Method:
A case report published in leading Hungarian-, German- and Italian-language medical journals in the early 1840s was revisited.
Results:
In 1830, an 18-year-old, healthy woman suffered epileptic seizures, followed by a 6-day-long state characterized by catalepsy, unresponsiveness, motionless, and light breathing. Her symptoms regularly returned in the following 1.5 years. Meanwhile, a progressively growing huge abdominal tumor appeared. One day, she suddenly started vomiting a large amount of foul-smelling pus mixed with blood, accompanied by bone fragments. Pus mixed blood with some membranous substance was also evacuated through the anus and vagina. After this event, she completely recovered; 1.5 years later, she married and later gave birth to 3 healthy children. The patient remained healthy during the 11-year follow-up.
Conclusions:
We suggest that in the description of a paraneoplastic case, an anti-NMDA receptor encephalitis can be dated back as far as to the 19th century, with an especially rare type of resolution: the disappearance of the symptoms after the spontaneous elimination of an ovarian teratoma.
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