Rinsho Shinkeigaku (Clinical Neurology)

Case Report

A case of anti-N-methyl-D-aspartate receptor encephalitis with ovarian teratoma showing excellent recovery with decreasing of anti-N-methyl-D-aspartate receptor antibody

Yoshiharu Taguchi, M.D.1), Shutaro Takashima, M.D.1), Shiho Takano, M.D.2), Hisashi Mori, PhD.2) and Kortaro Tanaka, M.D.1)

1)The Department of Neurology, Toyama University Hospital
2)The Department of Molecular Neuroscience, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama

We report a case of a 17-year-old woman with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, who developed psychiatric symptoms. Pelvic MRI revealed a right ovarian tumor that was suspected of being an ovarian teratoma. On the 27th day after onset, the patient underwent right salpingo-oophorectomy. The histopathological diagnosis was immature ovarian teratoma. Subsequently, 4 double filtration plasmapheresises (DFPP) were performed from day 34 to day 43. Methylprednisolone (1,000 mg/day for 3 days) was started on day 38. With these treatments, consciousness disturbance completely improved, and the patient was discharged on day 50. The serum and cerebrospinal fluid were positive for antibodies against the GluR1 (NR1)-EGFP/GluRε2 (NR2B) heteromer and the GluRζ1 (NR1) subunit of NMDAR. The patient was hence diagnosed as having anti-NMDAR encephalitis with ovarian teratoma. Serial analysis show that the antibodies against NMDAR decreased with improvement of symptoms after the immunotherapy including DFPP treatment.
Full Text of this Article in Japanese PDF (855K)

(CLINICA NEUROL, 51: 499|504, 2011)
key words: NMDA receptor, limbic encephalitis, ovarian teratoma, double filtration plasmapheresis, anti-NMDAR antibody

(Received: 8-Feb-11)