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BMJ Case Reports 2018; doi:10.1136/bcr-2017-220333
  • Rare disease
  • CASE REPORT

Ovarian teratoma associated with anti-NMDA (N-methyl D-aspartate) receptor encephalitis

  1. Nordeen Bouhadiba1,3
  1. 1Department of Paediatric Surgery, Guy’s and St Thomas’s NHS Foundation Trust, London, UK
  2. 2Paediatric Surgery, Evelina Children’s Hospital, London, UK
  3. 3Evelina London Children’s Hospital, Guy’s and St Thomas NHS foundation Trust, London, UK
  1. Correspondence to Dr Nordeen Bouhadiba, nordeen.bouhadiba{at}gstt.nhs.uk
  • Accepted 20 February 2018
  • Published 13 March 2018

Summary

Anti-N-methyl D-aspartate receptor (NMDAR) encephalitis is a paraneoplastic, immune-mediated encephalopathy with a known association with ovarian teratomas. We present the first case in the UK of a 7-year-old patient presenting with this condition. Having been previously fit and healthy, the patient presented with an acute onset of cognitive disturbances. The initial suspicion was that of an infective encephalopathy; however, the lumbar puncture results were negative. Electroencephalography reported diffuse background slowing, supporting a diagnosis of encephalopathy. Extensive autoimmune screening was done and found to be positive for anti-NMDAR antibodies. A whole body MRI found a right adnexal lesion consistent with ovarian teratoma. At laparoscopy, the right ovary was excised and histology confirmed a mature cystic teratoma with neural tissue. There were no postoperative complications with the patient’s neurology recovering progressively at follow-up.

Footnotes

  • Contributors NL and HT: main content. DD and NB: conception and review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer AQ: Authors SURNAMES : surnames in capital letters Nellihela LEEL Hemanshoo S THAKKAR David DRAKE Nordeen BOUHADIBAAQ: Affiliation Evelina London Children’s Hospital, Guy’s & St-Thomas NHS foundation Trust, London, UKAQ: Funding no competing intersts no grant have been allocated for this research from any funding agency in the public, commercial or not-for-profit sectors

  • Competing interests None declared.

  • Patient consent Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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