J Korean Neuropsychiatr Assoc.  2015 Nov;54(4):596-599. 10.4306/jknpa.2015.54.4.596.

A Case of Paraneoplastic Limbic Encephalitis Presented with Schizophrenic Symptoms

• Shin KS
• Cheon EJ
• Lee SJ

• KMID: 2149344
• DOI: http://doi.org/10.4306/jknpa.2015.54.4.596

Abstract

Paraneoplastic limbic encephalitis associated with ovarian teratoma has variable clinical manifestations, including hallucination, abnormal behavior, amnesia, mental change, fever, chorea and dystonia, and often has antibodies to N-methyl-D-aspartate receptor (NMDAR), however cases without tumor or antibodies to NMDAR have also been reported. Here, we describe a 35-year-old female who was initially misdiagnosed as schizophrenia because she presented with acute onset of psychiatric symptoms, including visual hallucination, abnormal behavior, confusion, and memory impairment. Three days after admission, she developed high fever refractory to antibiotics. Brain MRI and examination of cerebrospinal fluid were normal. Computerized tomography of the pelvis showed an ovarian teratoma. The patient showed complete improvement after surgical removal of the ovarian teratoma and steroid therapy. We suggest that physicians should consider the possibility of paraneoplastic limbic encephalitis in patients who present with acute onset of psychiatric symptoms with high fever or movement disorder.

Keyword

Limbic encephalitis; Paraneoplastic; Ovarian teratoma; Schizophrenia

MeSH Terms

Adult
Amnesia
Anti-Bacterial Agents
Antibodies
Brain
Cerebrospinal Fluid
Chorea
Dystonia
Female
Fever
Hallucinations
Humans
Limbic Encephalitis*
Magnetic Resonance Imaging
Memory
Movement Disorders
N-Methylaspartate
Pelvis
Schizophrenia
Teratoma
Anti-Bacterial Agents
Antibodies
N-Methylaspartate

Figure

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  Fig. 1 The initial brain MRI of the patient. The axial fluid attenuation inversion recovery imaging shows no abnormalities.

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  Fig. 2 Pelvic CT of the patient. Pelvic CT demonstrates 5.5 cm sized cystic mass lesion containing calcification and fat in the right adnexa (arrow).

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