A case of anti-N-methyl-D-aspartate receptor encephalitis with associated ovarian teratoma in a 23-year-old female

Anti-N-methyl-D-aspartate (anti-NMDA) receptor encephalitis is an immune-mediated disease manifesting with a complex neuropsychiatric syndrome and anti-NMDA receptor antibodies within the cerebrospinal fluid. If not treated, it can progress to hypoventilation, coma, or death. It is often misdiagnosed as drug abuse, neuroleptic malignant syndrome, primary psychiatric disorder, or viral encephalitis. Despite its severity, the condition is highly responsive to treatment through decreasing antibody titers, and much of the potential morbidity can be avoided if it is recognized quickly. This case report describes a 23-year-old female from South Korea with no significant past medical history who presented to the emergency department with memory loss and migraine for 1 week. High levels of anti-NMDA receptors were identified. The diagnosis of anti-NMDA receptor encephalitis was further supported by computed tomography and magnetic resonance imaging findings of encephalitis and an ovarian teratoma, a common associated finding. Despite aggressive treatment with intravenous immunoglobulin, glucocorticoids and monoclonal antibodies, the patient failed to demonstrate a normal level of consciousness for the majority of the admission period and contracted numerous nosocomial infections. This case of a young, previously-well female outlines the need for early detection and treatment of this condition, considering the severe symptoms and deleterious outcomes. Its diagnosis relies on physicians having a high index of suspicion in young females presenting with acute psychiatric and neurological symptoms, as well as a focus on early appropriate radiological imaging. Further research is necessary on anti-NMDA-related conditions so that a timely, multidisciplinary approach to screening, diagnosis and treatment can be initiated.