Article Text
Abstract
Ovarian teratomas are found in one-third of females presenting with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. When a teratoma is detected on imaging, its removal is first-line therapy. Even with multiple imaging modalities, occasionally, the teratoma is found only on subsequent imaging, long after initial presentation. Very rarely, patients have undergone oophorectomy despite negative imaging, with pathology demonstrating teratoma, and resulting clinical improvement. We present a patient in whom removal of a teratoma, not visible on conventional imaging, resulted in marked clinical improvement. Such cases present a major clinical challenge, needing to consider the risks of oophorectomy, including sterilisation and early menopause, versus the possibility of death in the absence of response to first-line (eg, corticosteroids, plasma exchange, intravenous immunoglobulin), second-line (eg, rituximab) and third-line (eg, bortezomib) immunosuppression. This decision is made more difficult as patients are usually females of childbearing age who at the time lack capacity to make medical decisions. This case also highlights the lack of consensus and guidelines for imaging modalities used to detect teratoma and when to pursue oophorectomy.
- NMDA
- Intensive care
- genitourinary medicine
- paraneoplastic syndrome
- quality of life
Statistics from Altmetric.com
Footnotes
DA and NN contributed equally
Contributors DA, NN and JM drafted the original manuscript. All authors were directly involved in the patient’s care and management, provided intellectual content for the manuscript, and edited the manuscript.
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.
Patient consent for publication Consent obtained from parent(s)/guardian(s).
Ethics approval The patient’s mother provided consent for publication of this case.
Provenance and peer review Not commissioned. Externally peer reviewed by Adam Al-Diwani, Oxford, UK.
Data availability statement Not applicable.
Request Permissions
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.
Copyright information:
Linked Articles
- Editors’ commentary
Read the full text or download the PDF:
Other content recommended for you
- Rapid recovery from catastrophic paraneoplastic anti-NMDAR encephalitis secondary to an ovarian teratoma following ovarian cystectomy
- Encephalitis on deployment in Kenya: think beyond the infections
- Clinical approach to the diagnosis and successful management of anti-NMDA receptor encephalitis when antibody testing is not possible
- Differential expression of antibodies to NMDA receptor in anti-NMDA receptor encephalitis and in neuropsychiatric systemic lupus erythematosus
- Primary lateral sclerosis - like picture in a patient with a remote history of anti-N - methyl - D - aspartate receptor (anti - NMDAR) antibody encephalitis
- Successful treatment of anti-N - methyl - D - aspartate receptor encephalitis presenting with catatonia
- Neurogenic bladder in an adolescent woman with an ovarian tumour: an unusual presentation of anti-NMDA - receptor encephalitis
- Fluorodeoxyglucose positron emission tomography in anti-N - methyl - D - aspartate receptor encephalitis: distinct pattern of disease
- NMDAR (N - methyl - D - aspartate receptor) encephalitis in a patient with MS (multiple sclerosis): a rare and challenging case
- Treatment responsive opsoclonus – ataxia associated with ovarian teratoma