A case of hysteria: anti-N-methyl-D-aspartate receptor encephalitis resulting from a mature ovarian teratoma

Abstract

Anti-N-methyl-D-aspartate receptor encephalitis in young healthy women while rare may be the result of an ovarian teratoma that produces anti-NMDA receptor antibodies. Symptoms from this encephalitis can be severe enough to result in hypoventilation, autonomic instability, and coma. Although treatable with tumor removal via oophorectomy and immunosuppression, median time to diagnosis is 8 weeks, which may lead to the onset of severe symptoms. The case presented highlights the severity of symptoms including rhabdomyolysis and respiratory distress in a female who had a previous history of functional somatic syndromes, which possibly resulted in a delayed diagnosis. This case demonstrates the importance of a thorough evaluation for causes of new onset neurological symptoms when the patient’s clinical status continues to deteriorate. This includes an evaluation for anti-N-methyl-D-aspartate receptor encephalitis. Following salpingo-oophorectomy, IVIG/methylprednisolone, and rituximab/cyclophosphamide treatment, this patient demonstrated improvement although she continues to require rehabilitation therapy, maintenance Keppra and low-dose Prednisone.