A patient with encephalitis associated with NMDA receptor antibodies.
BACKGROUND
A 34-year-old woman presented with headache, feverish sensation and anxiety, rapidly followed by homicidal ideation, aggressive agitation, seizures, hypoventilation, hyperthermia and prominent autonomic instability requiring intubation and sedation. She developed episodes of hypotension and bradycardia with periods of asystole lasting up to 15 seconds. Upon weaning off sedation, her eyes opened but she was unresponsive to stimuli. There was muscle rigidity, frequent facial grimacing, rhythmic abdominal contractions, kicking motions of the legs, and intermittent dystonic postures of the right arm.


METHODS
Routine laboratory testing, toxicology screening, studies for autoimmune and infectious etiologies, brain MRI scan, lumbar puncture, electroencephalogram, whole-body CT scan, abdominal ultrasound, paraneoplastic and voltage-gated potassium channel antibody serologies, analysis of N-methyl-D-aspartate receptor antibodies.


METHODS
Paraneoplastic encephalitis associated with immature teratoma of the ovary and N-methyl-D-aspartate receptor antibodies.


RESULTS
Intensive care, mechanical ventilation, antiepileptics, laparotomy and left salpingo-oophorectomy, corticosteroids, plasma exchange, intravenous immunoglobulin, cyclophosphamide, physical therapy, and chemotherapy.
Sansing
Lauren H
LH
Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Tüzün
Erdem
E
Ko
Melissa W
MW
Baccon
Jennifer
J
Lynch
David R
DR
Dalmau
Josep
J
D000328:Adult; D000906:Antibodies / Q000134:cerebrospinal fluid*; D004660:Encephalitis / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy; D005260:Female; D006801:Humans; D020361:Paraneoplastic Syndromes, Nervous System / Q000175:diagnosis / Q000276:immunology / Q000628:therapy; D016194:Receptors, N-Methyl-D-Aspartate / Q000276:immunology*; D013724:Teratoma / Q000175:diagnosis / Q000276:immunology / Q000628:therapy
D000906:Antibodies; D016194:Receptors, N-Methyl-D-Aspartate