Appearance of anti-NMDAR antibodies after plasma exchange and total removal of malignant ovarian teratoma in a patient with paraneoplastic limbic encephalopathy.
A 29-year-old female was admitted under section 2 of the mental health act with an acute psychosis. Her condition deteriorated as she developed a fever and worsening hallucinations. Brain imaging was normal but a lumbar puncture revealed a reactive cerebrospinal fluid. A transvaginal ultrasound revealed a left ovarian mass suggestive of a teratoma. A diagnosis of anti-N-methyl-D-aspartic acid receptor (NMDAR) limbic encephalitis was made but the anti-NMDAR antibody was found to be negative. The patient proceeded to a laparoscopic oopherectomy and a 5-day course of plasma exchange. The patient has made a gradual improvement and the anti-NMDAR antibody has since become positive.
Department of Neurology, King's College Hospital, London, UK. sarah.wali@kcl.ac.uk
Sarah M
SM
Wali
Andrew
A
Cai
Alexander M
AM
Rossor
Christopher
C
Clough
D000328:Adult; D060426:Anti-N-Methyl-D-Aspartate Receptor Encephalitis / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D001323:Autoantibodies / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D010051:Ovarian Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D010052:Ovariectomy; D010951:Plasma Exchange; D013724:Teratoma / Q000150:complications* / Q000175:diagnosis / Q000601:surgery
D001323:Autoantibodies; D015415:Biomarkers