Paraneoplastic Encephalitis Due to Anti-NMDA Receptor Antibodies in a Young Woman with Ovarian Teratoma

Gonzalez Manrique Guillermo; Zabaleta Orozco Mario Alberto; Claros Ortiz Katherine Viviana; Cano Arias Luis Guillermo; Velasco Hoyos Maria Fernanda; Solano Vega Irina Isabel; Lizcano Aros Jose Alfredo; Luna Tavera Rina Liliana

doi:doi:10.11648/j.ejcbs.20230904.12

Paraneoplastic Encephalitis Due to Anti-NMDA Receptor Antibodies in a Young Woman with Ovarian Teratoma

Gonzalez Manrique Guillermo, Zabaleta Orozco Mario Alberto, Claros Ortiz Katherine Viviana, Cano Arias Luis Guillermo, Velasco Hoyos Maria Fernanda, Solano Vega Irina Isabel, Lizcano Aros Jose Alfredo, Luna Tavera Rina Liliana

Published in European Journal of Clinical and Biomedical Sciences (Volume 9, Issue 4)

Received: 16 March 2023 Accepted: 1 April 2023 Published: 25 September 2023

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Abstract

Anti-N-methyl D-aspartate receptor (NMDAR) encephalitis is a rare condition, often associated with neoplasms and characterized by neuropsychiatric symptoms and dysautonomia. Affecting approximately 0.01% of cancer patients, it is the second most frequent autoimmune encephalitis after acute disseminated encephalomyelitis, its clinical presentation is usually acute and severe, so prompt identification and treatment improve prognosis. We present the case of a 23-year-old female patient from a rural area of Caquetá, Colombia, previously healthy, who presented persistent psychotic symptoms of two weeks of evolution and was initially treated in a psychiatric unit where she evolved with systemic compromise. Finally, a diagnosis of paraneoplastic anti-NDMAR encephalitis was made. The patient received IV immunoglobulin G plus adjuvant systemic management with chemotherapy. She had complete resolution of her neuropsychiatric disorder and was asymptomatic when discharged. In conclusion, anti-NMDAR encephalitis is a condition with an underlying autoimmune mechanism, with production of autoantibodies mainly against the NR1 and NR2 subunits of NMDA receptors in the brain. These autoantibodies are produced in response to a breakdown of immune tolerance usually secondary to a neoplastic process, mostly ovarian teratoma, or infectious as in the case of herpes viral encephalitis. Despite its severe and potentially fatal nature, AE typically exhibits a positive response to treatment if a prompt diagnosis is established and management is initiated. However, it is acknowledged in some texts that there is still a gap in recognizing this entity, which encourages future valuable research.

Published in	European Journal of Clinical and Biomedical Sciences (Volume 9, Issue 4)
DOI	10.11648/j.ejcbs.20230904.12
Page(s)	51-54
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2023. Published by Science Publishing Group

Keywords

Anti-N-Methyl-D-Aspartate Receptor Encephalitis, Encephalitis, Psychosis, Autoimmune Diseases, Paraneoplastic Encephalitis

References

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[2]	Patel, A., Koul, P., & Lado, F. (2021). The Autoimmune Encephalitis: Historical Overview (2587). Neurology, 96 (15 Supplement), 2587.
[3]	Vogrig A, Gigli GL, Segatti S, Corazza E, Marini A, Bernardini A, et al. Epidemiology of paraneoplastic neurological syndromes: a population-based study. Journal of Neurology. 2020; 267 (1): 26–35.
[4]	Midgley, L., Kelleher, E., & Zandi, M. S. Autoimmune encephalitis. British Journal of Hospital Medicine. 2018; 79 (9), C134–C137.
[5]	Dalmau J, Tüzün E, Wu HY, Masjuan J, Rossi JE, Voloschin A, Baehring JM, Shimazaki H, Koide R, King D, Mason W, Sansing LH, Dichter MA, Rosenfeld MR, Lynch DR. Paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma. Ann Neurol. 2007; 61 (1): 25-36.
[6]	Vaux, A., Robinson, K., Saglam, B., Cheuk, N., Kilpatrick, T., Evans, A., & Monif, M. Autoimmune Encephalitis in Long-Standing Schizophrenia: A Case Report. Frontiers in Neurology. 2022. 12, 1–7.
[7]	Prüss H, Dalmau J, Harms L, Höltje M, Ahnert-Hilger G, Borowski K, et al. Retrospective analysis of NMDA receptor antibodies in encephalitis of unknown origin. Neurology. 2010; 75 (19): 1735–9.
[8]	Abboud H, Probasco JC, Irani S, Ances B, Benavides DR, Bradshaw M, et al. Autoimmune encephalitis: Proposed best practice recommendations for diagnosis and acute management. Vol. 92, Journal of Neurology, Neurosurgery and Psychiatry. BMJ; 2021. p. 757–68.
[9]	Lee WJ, Lee ST, Byun JI, Sunwoo JS, Kim TJ, Lim JA, et al. Rituximab treatment for autoimmune limbic encephalitis in an institutional cohort. Neurology. 2016 May 3; 86 (18): 1683–91.
[10]	Gresa-Arribas N, Titulaer MJ, Torrents A, et al. Antibody titres at diagnosis and during follow-up of anti-NMDA receptor encephalitis: a retrospective study. Lancet Neurol 2014; 13: 167.
[11]	Vedeler CA, Antoine JC, Giometto B, et al. Management of paraneoplastic neurological syndromes: report of an EFNS Task Force. Eur J Neurol 2006; 13: 682.
[12]	Lejuste F, Thomas L, Picard G, et al. Neuroleptic intolerance in patients with anti-NMDAR encephalitis. Neurol Neuroimmunol Neuroinflamm 2016; 3: e280.
[13]	Granerod J, Dphil A, Clewley JP, Walsh AL, Morgan D, Brown Frcpath WG, et al. Causes of encephalitis and diff erences in their clinical presentations in England: a multicentre, population- based prospective study. Lancet Infect Dis. 2010 Dec; 10 (12): 835-44.
[14]	Lawn ND, Westmoreland BF, Kiely MJ, et al. Clinical, magnetic resonance imaging, and electroencephalographic findings in paraneoplastic limbic encephalitis. Mayo Clin Proc 2003; 78: 1363.
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Gonzalez Manrique Guillermo, Zabaleta Orozco Mario Alberto, Claros Ortiz Katherine Viviana, Cano Arias Luis Guillermo, Velasco Hoyos Maria Fernanda, et al. (2023). Paraneoplastic Encephalitis Due to Anti-NMDA Receptor Antibodies in a Young Woman with Ovarian Teratoma. European Journal of Clinical and Biomedical Sciences, 9(4), 51-54. https://doi.org/10.11648/j.ejcbs.20230904.12

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ACS Style

Gonzalez Manrique Guillermo; Zabaleta Orozco Mario Alberto; Claros Ortiz Katherine Viviana; Cano Arias Luis Guillermo; Velasco Hoyos Maria Fernanda, et al. Paraneoplastic Encephalitis Due to Anti-NMDA Receptor Antibodies in a Young Woman with Ovarian Teratoma. Eur. J. Clin. Biomed. Sci. 2023, 9(4), 51-54. doi: 10.11648/j.ejcbs.20230904.12

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AMA Style

Gonzalez Manrique Guillermo, Zabaleta Orozco Mario Alberto, Claros Ortiz Katherine Viviana, Cano Arias Luis Guillermo, Velasco Hoyos Maria Fernanda, et al. Paraneoplastic Encephalitis Due to Anti-NMDA Receptor Antibodies in a Young Woman with Ovarian Teratoma. Eur J Clin Biomed Sci. 2023;9(4):51-54. doi: 10.11648/j.ejcbs.20230904.12

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@article{10.11648/j.ejcbs.20230904.12,
  author = {Gonzalez Manrique Guillermo and Zabaleta Orozco Mario Alberto and Claros Ortiz Katherine Viviana and Cano Arias Luis Guillermo and Velasco Hoyos Maria Fernanda and Solano Vega Irina Isabel and Lizcano Aros Jose Alfredo and Luna Tavera Rina Liliana},
  title = {Paraneoplastic Encephalitis Due to Anti-NMDA Receptor Antibodies in a Young Woman with Ovarian Teratoma},
  journal = {European Journal of Clinical and Biomedical Sciences},
  volume = {9},
  number = {4},
  pages = {51-54},
  doi = {10.11648/j.ejcbs.20230904.12},
  url = {https://doi.org/10.11648/j.ejcbs.20230904.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ejcbs.20230904.12},
  abstract = {Anti-N-methyl D-aspartate receptor (NMDAR) encephalitis is a rare condition, often associated with neoplasms and characterized by neuropsychiatric symptoms and dysautonomia. Affecting approximately 0.01% of cancer patients, it is the second most frequent autoimmune encephalitis after acute disseminated encephalomyelitis, its clinical presentation is usually acute and severe, so prompt identification and treatment improve prognosis. We present the case of a 23-year-old female patient from a rural area of Caquetá, Colombia, previously healthy, who presented persistent psychotic symptoms of two weeks of evolution and was initially treated in a psychiatric unit where she evolved with systemic compromise. Finally, a diagnosis of paraneoplastic anti-NDMAR encephalitis was made. The patient received IV immunoglobulin G plus adjuvant systemic management with chemotherapy. She had complete resolution of her neuropsychiatric disorder and was asymptomatic when discharged. In conclusion, anti-NMDAR encephalitis is a condition with an underlying autoimmune mechanism, with production of autoantibodies mainly against the NR1 and NR2 subunits of NMDA receptors in the brain. These autoantibodies are produced in response to a breakdown of immune tolerance usually secondary to a neoplastic process, mostly ovarian teratoma, or infectious as in the case of herpes viral encephalitis. Despite its severe and potentially fatal nature, AE typically exhibits a positive response to treatment if a prompt diagnosis is established and management is initiated. However, it is acknowledged in some texts that there is still a gap in recognizing this entity, which encourages future valuable research.},
 year = {2023}
}

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TY  - JOUR
T1  - Paraneoplastic Encephalitis Due to Anti-NMDA Receptor Antibodies in a Young Woman with Ovarian Teratoma
AU  - Gonzalez Manrique Guillermo
AU  - Zabaleta Orozco Mario Alberto
AU  - Claros Ortiz Katherine Viviana
AU  - Cano Arias Luis Guillermo
AU  - Velasco Hoyos Maria Fernanda
AU  - Solano Vega Irina Isabel
AU  - Lizcano Aros Jose Alfredo
AU  - Luna Tavera Rina Liliana
Y1  - 2023/09/25
PY  - 2023
N1  - https://doi.org/10.11648/j.ejcbs.20230904.12
DO  - 10.11648/j.ejcbs.20230904.12
T2  - European Journal of Clinical and Biomedical Sciences
JF  - European Journal of Clinical and Biomedical Sciences
JO  - European Journal of Clinical and Biomedical Sciences
SP  - 51
EP  - 54
PB  - Science Publishing Group
SN  - 2575-5005
UR  - https://doi.org/10.11648/j.ejcbs.20230904.12
AB  - Anti-N-methyl D-aspartate receptor (NMDAR) encephalitis is a rare condition, often associated with neoplasms and characterized by neuropsychiatric symptoms and dysautonomia. Affecting approximately 0.01% of cancer patients, it is the second most frequent autoimmune encephalitis after acute disseminated encephalomyelitis, its clinical presentation is usually acute and severe, so prompt identification and treatment improve prognosis. We present the case of a 23-year-old female patient from a rural area of Caquetá, Colombia, previously healthy, who presented persistent psychotic symptoms of two weeks of evolution and was initially treated in a psychiatric unit where she evolved with systemic compromise. Finally, a diagnosis of paraneoplastic anti-NDMAR encephalitis was made. The patient received IV immunoglobulin G plus adjuvant systemic management with chemotherapy. She had complete resolution of her neuropsychiatric disorder and was asymptomatic when discharged. In conclusion, anti-NMDAR encephalitis is a condition with an underlying autoimmune mechanism, with production of autoantibodies mainly against the NR1 and NR2 subunits of NMDA receptors in the brain. These autoantibodies are produced in response to a breakdown of immune tolerance usually secondary to a neoplastic process, mostly ovarian teratoma, or infectious as in the case of herpes viral encephalitis. Despite its severe and potentially fatal nature, AE typically exhibits a positive response to treatment if a prompt diagnosis is established and management is initiated. However, it is acknowledged in some texts that there is still a gap in recognizing this entity, which encourages future valuable research.
VL  - 9
IS  - 4
ER  -

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Author Information

Gonzalez Manrique Guillermo

Neurophysiology Department, Hospital Universitario Hernando Moncaleano Perdomo, Investigation Group MI DNeuropsy, Neiva, Colombia
Zabaleta Orozco Mario Alberto

Neurophysiology Department, Hospital Universitario Hernando Moncaleano Perdomo, Investigation Group MI DNeuropsy, Neiva, Colombia
Claros Ortiz Katherine Viviana

Neurophysiology Department, Hospital Universitario Hernando Moncaleano Perdomo, Investigation Group MI DNeuropsy, Neiva, Colombia
Cano Arias Luis Guillermo

Gynecologic Oncology Department, Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Colombia
Velasco Hoyos Maria Fernanda

Internal Medicine Department, Universidad Surcolombiana, Investigation Group MI DNeuropsy, Neiva, Colombia
Solano Vega Irina Isabel

Internal Medicine Department, Universidad Surcolombiana, Investigation Group MI DNeuropsy, Neiva, Colombia
Lizcano Aros Jose Alfredo

Internal Medicine Department, Universidad Surcolombiana, Investigation Group MI DNeuropsy, Neiva, Colombia
Luna Tavera Rina Liliana

Department of Pathology, Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Colombia

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Plain Text BibTeX RIS

APA Style

Gonzalez Manrique Guillermo, Zabaleta Orozco Mario Alberto, Claros Ortiz Katherine Viviana, Cano Arias Luis Guillermo, Velasco Hoyos Maria Fernanda, et al. (2023). Paraneoplastic Encephalitis Due to Anti-NMDA Receptor Antibodies in a Young Woman with Ovarian Teratoma. European Journal of Clinical and Biomedical Sciences, 9(4), 51-54. https://doi.org/10.11648/j.ejcbs.20230904.12

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ACS Style

Gonzalez Manrique Guillermo; Zabaleta Orozco Mario Alberto; Claros Ortiz Katherine Viviana; Cano Arias Luis Guillermo; Velasco Hoyos Maria Fernanda, et al. Paraneoplastic Encephalitis Due to Anti-NMDA Receptor Antibodies in a Young Woman with Ovarian Teratoma. Eur. J. Clin. Biomed. Sci. 2023, 9(4), 51-54. doi: 10.11648/j.ejcbs.20230904.12

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AMA Style

Gonzalez Manrique Guillermo, Zabaleta Orozco Mario Alberto, Claros Ortiz Katherine Viviana, Cano Arias Luis Guillermo, Velasco Hoyos Maria Fernanda, et al. Paraneoplastic Encephalitis Due to Anti-NMDA Receptor Antibodies in a Young Woman with Ovarian Teratoma. Eur J Clin Biomed Sci. 2023;9(4):51-54. doi: 10.11648/j.ejcbs.20230904.12

Copy | Download

@article{10.11648/j.ejcbs.20230904.12,
  author = {Gonzalez Manrique Guillermo and Zabaleta Orozco Mario Alberto and Claros Ortiz Katherine Viviana and Cano Arias Luis Guillermo and Velasco Hoyos Maria Fernanda and Solano Vega Irina Isabel and Lizcano Aros Jose Alfredo and Luna Tavera Rina Liliana},
  title = {Paraneoplastic Encephalitis Due to Anti-NMDA Receptor Antibodies in a Young Woman with Ovarian Teratoma},
  journal = {European Journal of Clinical and Biomedical Sciences},
  volume = {9},
  number = {4},
  pages = {51-54},
  doi = {10.11648/j.ejcbs.20230904.12},
  url = {https://doi.org/10.11648/j.ejcbs.20230904.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ejcbs.20230904.12},
  abstract = {Anti-N-methyl D-aspartate receptor (NMDAR) encephalitis is a rare condition, often associated with neoplasms and characterized by neuropsychiatric symptoms and dysautonomia. Affecting approximately 0.01% of cancer patients, it is the second most frequent autoimmune encephalitis after acute disseminated encephalomyelitis, its clinical presentation is usually acute and severe, so prompt identification and treatment improve prognosis. We present the case of a 23-year-old female patient from a rural area of Caquetá, Colombia, previously healthy, who presented persistent psychotic symptoms of two weeks of evolution and was initially treated in a psychiatric unit where she evolved with systemic compromise. Finally, a diagnosis of paraneoplastic anti-NDMAR encephalitis was made. The patient received IV immunoglobulin G plus adjuvant systemic management with chemotherapy. She had complete resolution of her neuropsychiatric disorder and was asymptomatic when discharged. In conclusion, anti-NMDAR encephalitis is a condition with an underlying autoimmune mechanism, with production of autoantibodies mainly against the NR1 and NR2 subunits of NMDA receptors in the brain. These autoantibodies are produced in response to a breakdown of immune tolerance usually secondary to a neoplastic process, mostly ovarian teratoma, or infectious as in the case of herpes viral encephalitis. Despite its severe and potentially fatal nature, AE typically exhibits a positive response to treatment if a prompt diagnosis is established and management is initiated. However, it is acknowledged in some texts that there is still a gap in recognizing this entity, which encourages future valuable research.},
 year = {2023}
}

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TY  - JOUR
T1  - Paraneoplastic Encephalitis Due to Anti-NMDA Receptor Antibodies in a Young Woman with Ovarian Teratoma
AU  - Gonzalez Manrique Guillermo
AU  - Zabaleta Orozco Mario Alberto
AU  - Claros Ortiz Katherine Viviana
AU  - Cano Arias Luis Guillermo
AU  - Velasco Hoyos Maria Fernanda
AU  - Solano Vega Irina Isabel
AU  - Lizcano Aros Jose Alfredo
AU  - Luna Tavera Rina Liliana
Y1  - 2023/09/25
PY  - 2023
N1  - https://doi.org/10.11648/j.ejcbs.20230904.12
DO  - 10.11648/j.ejcbs.20230904.12
T2  - European Journal of Clinical and Biomedical Sciences
JF  - European Journal of Clinical and Biomedical Sciences
JO  - European Journal of Clinical and Biomedical Sciences
SP  - 51
EP  - 54
PB  - Science Publishing Group
SN  - 2575-5005
UR  - https://doi.org/10.11648/j.ejcbs.20230904.12
AB  - Anti-N-methyl D-aspartate receptor (NMDAR) encephalitis is a rare condition, often associated with neoplasms and characterized by neuropsychiatric symptoms and dysautonomia. Affecting approximately 0.01% of cancer patients, it is the second most frequent autoimmune encephalitis after acute disseminated encephalomyelitis, its clinical presentation is usually acute and severe, so prompt identification and treatment improve prognosis. We present the case of a 23-year-old female patient from a rural area of Caquetá, Colombia, previously healthy, who presented persistent psychotic symptoms of two weeks of evolution and was initially treated in a psychiatric unit where she evolved with systemic compromise. Finally, a diagnosis of paraneoplastic anti-NDMAR encephalitis was made. The patient received IV immunoglobulin G plus adjuvant systemic management with chemotherapy. She had complete resolution of her neuropsychiatric disorder and was asymptomatic when discharged. In conclusion, anti-NMDAR encephalitis is a condition with an underlying autoimmune mechanism, with production of autoantibodies mainly against the NR1 and NR2 subunits of NMDA receptors in the brain. These autoantibodies are produced in response to a breakdown of immune tolerance usually secondary to a neoplastic process, mostly ovarian teratoma, or infectious as in the case of herpes viral encephalitis. Despite its severe and potentially fatal nature, AE typically exhibits a positive response to treatment if a prompt diagnosis is established and management is initiated. However, it is acknowledged in some texts that there is still a gap in recognizing this entity, which encourages future valuable research.
VL  - 9
IS  - 4
ER  -

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