Acute Psychosis Triggered by Ovarian Teratoma: The Underdiagnosed yet Treatable Case of Anti-NMDA Receptor Encephalitis | Chapter 11 | Highlights on Medicine and Medical Research Vol. 6

 Anti-NMDA receptor (NMDAR) encephalitis is a newly discovered autoimmune condition characterised by prominent psychiatric symptoms. Acute behavioural changes, hallucinations, catatonic symptoms, memory deficits, epilepsy, dyskinesias, and autonomic dysfunction are common symptoms. An ovarian teratoma is often found in female patients. We present the case of a 32-year-old woman who was diagnosed with acute psychosis. She experienced generalised seizures and declined into a catatonic condition shortly after admission. Although ancillary tests such as an MRI, an electroencephalogram, and a cerebrospinal fluid (CSF) examination came back negative, the presence of acute psychosis, repeated seizures, and a persistent course indicated autoimmune encephalitis. An ovarian tumour was discovered during a pelvic ultrasound, prompting an immediate cystectomy with pathological evidence of a mature cystic ovarian teratoma. After that, plasmapheresis was started, which resulted in a partial response over the next two weeks. After high titers of anti-NMDAR antibodies were discovered in the CSF, the patient was given rituximab as a second-line immunosuppressive therapy. After six months of cognitive therapy, there was a significant change, though mild anterograde memory deficits persisted. The inclusion of anti-NMDAR encephalitis in the differential diagnosis of acute psychosis is highlighted in this article. It's important to include this condition in the differential diagnosis because early immunotherapy and tumour removal, if necessary, may have a big impact on the outcome.

Author (s) Details

Shikma Keller
Department of Psychiatry, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.

Pablo Roitman
Department of Psychiatry, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.

Tamir Ben-Hur
Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.

Tzahi Neuman
Brain Division and Department of Pathology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.

Omer Bonne
Department of Psychiatry, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.

Amit Lota
Department of Psychiatry, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.

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