Infect Chemother.  2015 Jun;47(2):129-132. 10.3947/ic.2015.47.2.129.

Fever of Unknown Origin: An Unusual Presentation of Anti-N-Methyl-D-Aspartate Receptor Encephalitis

Affiliations
  • 1Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea. sarang7529@hanmail.net

Abstract

Encephalitis associated with antibodies to the N-methyl-D-aspartate receptor (NMDAR) has variable clinical manifestations. Patients are often diagnosed with infectious processes because of prodromal symptoms and autonomic manifestations. Approximately 70% of patients have prodromal symptoms consisting of headache, fever, nausea, vomiting, and diarrhea, along with frequent autonomic manifestations, including tachycardia, and fluctuating blood pressure. A 36-year-old woman presented with uncontrolled fever and skin and soft tissue infections. She had shown psychiatric symptoms and abnormal behavior, and had been diagnosed with bipolar disorder. Antibodies to NMDAR were positive in cerebrospinal fluid (CSF) and serum samples, and pelvic computed tomography detected a large ovarian teratoma. The patient improved dramatically after removal of the teratoma and administration of corticosteroid therapy. When confronted with a young woman with uncontrolled fever and acute psychiatric symptoms, physicians should suspect anti-NMDAR encephalitis.

Keyword

Fever of unknown origin; Anti-N-methyl-D-aspartate receptor encephalitis; Dermoid cyst

MeSH Terms

Adult
Anti-N-Methyl-D-Aspartate Receptor Encephalitis*
Antibodies
Bipolar Disorder
Blood Pressure
Cerebrospinal Fluid
Dermoid Cyst
Diarrhea
Encephalitis
Female
Fever
Fever of Unknown Origin*
Headache
Humans
N-Methylaspartate
Nausea
Prodromal Symptoms
Skin
Soft Tissue Infections
Tachycardia
Teratoma
Vomiting
Antibodies
N-Methylaspartate

Figure

  • Figure 1 About 5.5 cm sized mixed density mass lesion is seen in right adnexa (arrow).


Reference

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