J Korean Med Sci.  2020 Jun;35(24):e207. 10.3346/jkms.2020.35.e207.

Anti-N-methyl-D-aspartate Receptor Encephalitis: a Rare Complication of Ovarian Teratoma

• Lee CH
• Kim EJ
• Lee MH
• Yim GW
• Kim KJ
• Kim KK
• Kim EJ
• Roh JW

• KMID: 2503016
• DOI: http://doi.org/10.3346/jkms.2020.35.e207

Abstract

Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a potentially life-threatening but reversible autoimmune disorder characterized by psychiatric symptoms, cognitive dysfunction, speech dysfunction, seizures, movement disorder, decreased level of consciousness, and autonomic dysfunction or central hypoventilation. It occurs predominantly in young women and approximately half of them have underlying tumors, mainly ovarian teratoma. A 24-year old woman was admitted because of fever, headache, abnormal movement and decreased mental status. Five cycles of plasmapheresis improved her neurological and mental status. Anti-NMDAR antibodies in her CSF and serum were positive, and computed tomography revealed a 1-cm sized mass suggestive of mature cystic teratoma arising from the right ovary. We promptly performed laparoscopic right ovarian cystectomy. She was discharged after 2 weeks with mild memory deficit. Prompt removal of ovarian teratoma and multidisciplinary care are particularly important for good outcome.

Keyword

Anti-N-methyl-D-aspartate Receptor Encephalitis; Autoimmune Encephalitis; Ovarian Teratoma

Figure

• 

  Fig. 1 Pathological examination of the resected ovarian tumor. (A) Histological findings of ovarian mass revealed typical feature of mature cystic teratoma consisting of ectodermal derivatives represented by squamous epithelium with adnexal structures, brain tissue including glia and ependymal tubule, mesodermal derivatives such as cartilage and adipose tissue, and endodermal derivatives such as gastrointestinal epithelium and salivary glands (hematoxylin and eosin stain, ×40). (B) Brain tissue in ovarian teratoma showed strong immunohistochemical reactivity for glial fibrillary acidic protein as evidence of glial tissues (×40).

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