Anti-N-Methyl-D-Aspartate Receptor (NMDAR) Encephalitis Associated With Mediastinal and Ovarian Teratomas: A Case Report

Abstract

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is the most common type of autoimmune encephalitis. Approximately 80% of patients with anti-NMDAR encephalitis are women. Tumors are detected in approximately 50% of female patients with anti-NMDAR encephalitis, of which 96% are ovarian teratomas. We describe the case of a 28-year-old woman diagnosed with anti-NMDAR encephalitis with mediastinal and bilateral ovarian teratomas in July 2019. The patient recovered following surgical management of the mediastinal mass and both ovarian teratomas, and immunotherapy. This case shows that teratomas can be found at multiple sites other than ovaries. Therefore, detecting teratomas using whole-body evaluation may be helpful for diagnosis and treatment.

The Leading Role of Brain and Abdominal Radiological Features in the Work-Up of Anti-NMDAR Encephalitis in Children: An Up-To-Date Review

“…Some studies have suggested an association between NMDARe and the HLA-I allele B*07:02 and HLA-II allele DRB1*16:02 [ 1 ]. According to the recent “Updated Diagnostic Criteria for Paraneoplastic Neurologic Syndromes”, NMDARe are considered neurologic syndromes at “intermediate risk”, associated with cancer in 30–70% of cases (mostly ovarian or extraovarian teratomas, such as mediastinal localizations), especially in females between 12 and 45 years of age (50% of all patients) [ 10 , 18 ]. On the other hand, women with ovarian teratomas generally have a low prevalence of anti-NMDAR antibodies, and those who develop autoimmune encephalitis seem to have smaller teratomas than those without NMDARe [ 10 ].…”