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Anti-N-methyl-D-aspartate receptor encephalitis with an imaging-invisible ovarian teratoma: a case report.
J Med Case Rep. 2016 Oct 24; 10(1):296.JM

Abstract

BACKGROUND

Anti-N-methyl-D-aspartate receptor encephalitis is a recently discovered disease entity of paraneoplastic limbic encephalitis. It largely affects young women and is often associated with an ovarian teratoma. It is a serious yet treatable condition if diagnosed early. Its remedy involves immunotherapy and surgical removal of the teratoma of the ovaries. This case of anti-N-methyl-D-aspartate receptor encephalitis involves an early surgical intervention with bilateral oophorectomy, despite negative imaging evidence of a teratoma.

CASE PRESENTATION

A 25-year-old white woman with anti-N-methyl-D-aspartate receptor encephalitis presented with behavioral changes and seizures that were confirmed to be secondary to anti-N-methyl-D-aspartate receptor encephalitis. She required an admission to our intensive care unit for ventilator support and received a number of immunological therapies. Multiple imaging investigations showed no evidence of an ovarian teratoma; she had a bilateral oophorectomy 29 days after admission. Ovarian histology confirmed the presence of a teratoma with neuronal cells. A few days after the operation she began to show signs of improvement and, apart from mild short-term memory loss, she returned to normal function.

CONCLUSIONS

Our patient is an example of teratoma-associated anti-N-methyl-D-aspartate receptor encephalitis, in which the teratoma was identified only microscopically. Her case highlights that even with negative imaging evidence of a teratoma, ovarian pathology should still be considered and explored.

Authors+Show Affiliations

Department of Medicine, Joondalup Health Campus, Joondalup, Western Australia, Australia. Academy of Neurology, Joondalup Health Campus, Joondalup, Western Australia, Australia. Neurodegenerative Disorders Research Pty Ltd, 4 Lawrence Avenue, West Perth, Western Australia, 6005, Australia.Department of Medicine, Joondalup Health Campus, Joondalup, Western Australia, Australia. research@ndr.org.au. Academy of Neurology, Joondalup Health Campus, Joondalup, Western Australia, Australia. research@ndr.org.au. Neurodegenerative Disorders Research Pty Ltd, 4 Lawrence Avenue, West Perth, Western Australia, 6005, Australia. research@ndr.org.au. Department of Medicine, The University of Western Australia, Perth, Western Australia, Australia. research@ndr.org.au.Ramsay Health, Joondalup Health Campus, Joondalup, Western Australia, Australia.Ramsay Health, Joondalup Health Campus, Joondalup, Western Australia, Australia.Ramsay Health, Joondalup Health Campus, Joondalup, Western Australia, Australia.Ramsay Health, Joondalup Health Campus, Joondalup, Western Australia, Australia.Ramsay Health, Joondalup Health Campus, Joondalup, Western Australia, Australia.Western Diagnostic Pathology, Joondalup Health Campus, Joondalup, Western Australia, Australia.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

27776544

Citation

Abdul-Rahman, Zainab M., et al. "Anti-N-methyl-D-aspartate Receptor Encephalitis With an Imaging-invisible Ovarian Teratoma: a Case Report." Journal of Medical Case Reports, vol. 10, no. 1, 2016, p. 296.
Abdul-Rahman ZM, Panegyres PK, Roeck M, et al. Anti-N-methyl-D-aspartate receptor encephalitis with an imaging-invisible ovarian teratoma: a case report. J Med Case Rep. 2016;10(1):296.
Abdul-Rahman, Z. M., Panegyres, P. K., Roeck, M., Hawkins, D., Bharath, J., Grolman, P., Neppe, C., & Palmer, D. (2016). Anti-N-methyl-D-aspartate receptor encephalitis with an imaging-invisible ovarian teratoma: a case report. Journal of Medical Case Reports, 10(1), 296.
Abdul-Rahman ZM, et al. Anti-N-methyl-D-aspartate Receptor Encephalitis With an Imaging-invisible Ovarian Teratoma: a Case Report. J Med Case Rep. 2016 Oct 24;10(1):296. PubMed PMID: 27776544.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anti-N-methyl-D-aspartate receptor encephalitis with an imaging-invisible ovarian teratoma: a case report. AU - Abdul-Rahman,Zainab M, AU - Panegyres,Peter K, AU - Roeck,Margareta, AU - Hawkins,David, AU - Bharath,Jude, AU - Grolman,Paul, AU - Neppe,Cliffe, AU - Palmer,David, Y1 - 2016/10/24/ PY - 2016/06/03/received PY - 2016/09/13/accepted PY - 2016/10/26/pubmed PY - 2017/5/13/medline PY - 2016/10/26/entrez KW - Case report KW - Encephalitis KW - NMDA receptor KW - Oophorectomy KW - Paraneoplastic KW - Teratoma SP - 296 EP - 296 JF - Journal of medical case reports JO - J Med Case Rep VL - 10 IS - 1 N2 - BACKGROUND: Anti-N-methyl-D-aspartate receptor encephalitis is a recently discovered disease entity of paraneoplastic limbic encephalitis. It largely affects young women and is often associated with an ovarian teratoma. It is a serious yet treatable condition if diagnosed early. Its remedy involves immunotherapy and surgical removal of the teratoma of the ovaries. This case of anti-N-methyl-D-aspartate receptor encephalitis involves an early surgical intervention with bilateral oophorectomy, despite negative imaging evidence of a teratoma. CASE PRESENTATION: A 25-year-old white woman with anti-N-methyl-D-aspartate receptor encephalitis presented with behavioral changes and seizures that were confirmed to be secondary to anti-N-methyl-D-aspartate receptor encephalitis. She required an admission to our intensive care unit for ventilator support and received a number of immunological therapies. Multiple imaging investigations showed no evidence of an ovarian teratoma; she had a bilateral oophorectomy 29 days after admission. Ovarian histology confirmed the presence of a teratoma with neuronal cells. A few days after the operation she began to show signs of improvement and, apart from mild short-term memory loss, she returned to normal function. CONCLUSIONS: Our patient is an example of teratoma-associated anti-N-methyl-D-aspartate receptor encephalitis, in which the teratoma was identified only microscopically. Her case highlights that even with negative imaging evidence of a teratoma, ovarian pathology should still be considered and explored. SN - 1752-1947 UR - https://www.unboundmedicine.com/medline/citation/27776544/Anti_N_methyl_D_aspartate_receptor_encephalitis_with_an_imaging_invisible_ovarian_teratoma:_a_case_report_ L2 - https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-016-1067-4 DB - PRIME DP - Unbound Medicine ER -