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  • Clinical approach to the diagnosis and successful management of anti-NMDA receptor encephalitis when antibody testing is not possible

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Rare disease
Case report
Clinical approach to the diagnosis and successful management of anti-NMDA receptor encephalitis when antibody testing is not possible
  1. Anil Frank Ramlackhansingh1,
  2. Alexi Christopher King2,
  3. Shamera Maharaj3 and
  4. David Joseph King4
  1. 1 Department of Adult Medicine, University of the West Indies at Saint Augustine Faculty of Medical Sciences, Saint Augustine, Trinidad and Tobago
  2. 2 Medicine, Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
  3. 3 Internal Medicine, Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
  4. 4 Department of Internal Medicine, North West Regional Health Authority, Port of Spain, Trinidad and Tobago
  1. Correspondence to Dr Anil Frank Ramlackhansingh, anil.ramlackhansingh{at}sta.uwi.edu

Abstract

Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is a multistage illness that progresses from psychosis, memory deficits, seizures and language disintegration to a state of unresponsiveness with catatonic features often associated with abnormal movements, and autonomic and breathing instability. While the disorder predominantly affects children and young adults, and occurs with or without tumour association, the presence of a tumour (usually an ovarian teratoma) is dependent on the age, sex and ethnicity.Teratomas present more frequently in women older than 18 years, and are more predominant in black women than Caucasians. Here we present the case of a patient with probable anti-NMDA receptor encephalitis. She was subsequently found to have a mature teratoma of the ovary (dermoid cyst). Despite immune-modulated therapy, surgery was eventually performed to remove the cyst. This was met with a good clinical recovery.

  • epilepsy and seizures
  • gynecological cancer

https://doi.org/10.1136/bcr-2019-229593

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    Footnotes

    • Contributors AFR conceptualised this report and provided reviewed submitted scripts. ACK provided writing support and review of articles. SM provided support in the review of articles and review of written scripts. DJK provided support in the review of articles and review of written scripts.

    • 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.

    • Competing interests None declared.

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

    • Patient consent for publication Obtained.