OMS4 Liberty University College of Osteopathic Medicine Forest, Virginia, United States
Case Diagnosis: Anti-NMDA receptor encephalitis secondary to ovarian teratoma.
Case Description: A 14-year-old female patient presented to her PCP with fever of 102, altered mental status, and headaches.Parents reported over the past 3 days she had new onset of insomnia with headaches and was complaining of auditory and visual hallucinations.Patient was noted to have slurred speech and oculomotor dysfunction, she was promptly referred to the ED due to the severity of symptoms.Top differentials in the ED consisted of encephalitis (viral, toxic, metabolic, bacterial, or autoimmune), acute psychosis, space occupying lesion of the brain, and atypical migraine.Toxin and CBC report were unremarkable.Patient was admitted to neurology and started on empiric treatment. Lumbar puncture failed to yield enough CSF for testing. On EEG patient was noted to have subclinical seizures.On US A/P a left sided ovarian cyst >3cm with irregular borders was detected.Surgical pathology of cyst was consistent with cystic teratoma involving glial components.
Discussions: Anti-NMDA receptor encephalitis is a rare inflammation of the brain caused by acquired antibodies.The infrequency of the diagnosis commonly leads to it being towards the end of the list of differential diagnosis.Many times, other more recognized diagnoses are ruled out first; including HSV encephalitis and acute psychosis.Anti-NMDA receptor encephalitis in females is frequently secondary to ovarian teratomas.The disease has severe psychiatric and neurologic manifestations, the treatment consisting of tumor resection and immunotherapy tend to be curative.
Conclusions: Although Anti-NMDA receptor encephalitis is rare, providers should have a high degree of clinical suspicion when rapid acute neurologic and psychiatric symptoms present in a female patient in absence of viral or bacterial origin.
