Ovarian Teratoma as an Uncommon Cause of Encephalitis: Anti-Nmdar Syndrome, A Case Report
Corresponding AuthorLourdes Sala Climent
Department of Obstetrics and Gynecology, University Hospital Arnau de Vilanova, Lérida, Spain
A B S T R A C T
Objective: Anti-N-methyl D-aspartate receptor (NMDAR) encephalitis is a paraneoplastic, immunemediated encephalopathy with a known association with ovarian tumors, more frequently with mature teratoma. Case Report: We present the case of a 20-year-old patient presenting with fever for 3 weeks and an acute onset of cognitive disturbances. The initial suspicion was that of an infective encephalopathy; however, the lumbar puncture results were negative. Electroencephalography reported epileptiform activity in anterior horns, supporting a diagnosis of encephalopathy. Extensive autoimmune screening was done and found to be positive for anti-NMDAR antibodies. A whole body-TC found a right adnexal tumor compatible with ovarian teratoma. At laparoscopy, the right adnexal tumor was excised, preserving most of the ovarian parenchyma; and histology confirmed a mature teratoma with neural tissue. There were no postoperative complications. The patient recovered normal speech and her former cognitive status, within 40 days from the day after surgery. Conclusion: The association ovarian teratoma-anti-NMDAR encephalitis is a serious and potentially fatal pathology occurring in young women and under-recognized in many countries and among gynaecologists. Given the recent discovery, special attention should be given to possible behavioural changes and psychiatric symptoms that may occur in young women with apparently unknown cause. It is also very important the diagnostic confirmation through the positivity of the anti-NMDAR antibodies, the diagnosis of the underlying tumour and the early tumour excision; since, the earlier the treatment is, the greater is the rate of success and the clinical remission.
Article TypeCase Report
Publication historyReceived: Thu 19, Dec 2019
Accepted: Tue 31, Dec 2019
Published: Fri 10, Jan 2020
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