Anti-N-methyl-D-aspartate receptor antibody (anti-NMDAR) encephalitis: A case report

Abstract

Anti-NMDA receptor (NMDAR) encephalitis is an autoimmune encephalitis that can be paraneoplastic and usually responds to treatment. It has been well described in young women with ovarian teratoma. The classic presentation of this syndrome is a subacute encephalopathy with mood disturbances, including psychosis, with variability of seizures and movement disorders. We present a case of a woman in her 30s who developed psychiatric symptoms that progressed to encephalopathy, seizures, autonomic instability, and hyperkinetic movements. The patient has an ovarian teratoma and serum and cerebrospinal fluid NMDAR antibodies. Treatment included first-line immunotherapy (steroids, intravenous immunoglobulin, plasmapheresis), second-line immunotherapy (rituximab), and tumor removal. Not all patients, however, respond well to such treatments initially and, consequently, these individuals can require aggressive second-line immunotherapies. Whether these therapies promote disease’s recovery has been a subject of controversy.