Concurrent NMDAR and GFAP Antibody Encephalitis During Pregnancy

Area of Science:

• Neuroimmunology
• Neurology

Background:

• Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a severe autoimmune neurological disorder often linked to ovarian teratomas, primarily affecting young women.
• Typical symptoms include altered consciousness, psychosis, movement disorders, seizures, and autonomic dysfunction, often requiring intensive care.

Observation:

• This case presents the first documented instance of concurrent NMDAR and anti-glial fibrillary acidic protein (GFAP) antibody encephalitis in a pregnant patient with an ovarian teratoma.
• The patient underwent teratoma removal and immunosuppressive therapy, but significant neurological improvement was observed only after childbirth.

Findings:

• The co-occurrence of NMDAR and GFAP antibody encephalitis in pregnancy poses unique diagnostic and therapeutic challenges.
• Postpartum neurological recovery suggests a potential influence of pregnancy-related factors on disease course and treatment response.

Implications:

• This case highlights the importance of considering concurrent autoimmune encephalitis in pregnant women, especially with teratoma.
• Early diagnosis, multidisciplinary management including teratoma removal and immunosuppression, and consideration of delivery timing are crucial for favorable outcomes in both mother and child.