Psychosis secondary to an incidental teratoma: a “heads-up” for psychiatrists and gynecologists

Abstract

Anti-N-methyl-D-aspartate receptor encephalitis is a potentially fatal form of autoimmune encephalitis that originates secondary to a host immune response to neural tissue within a teratoma. We describe the case of a 17-year old girl who presented with acute onset psychosis, catatonic movements, urinary incontinence, fever, tachycardia, and fluctuating periods of hypotension and hypertension. A CT scan demonstrated an incidental 6 cm ovarian teratoma. The patient fully recovered after ovarian cystectomy, followed by medical management with intravenous immunoglobins and plasmapheresis. Anti-N-methyl-D-aspartate receptor encephalitis is an important differential diagnosis to consider for young patients presenting with acute onset psychiatric symptoms, who develop seizures, movement disorders, or autonomic instability. It is important for psychiatrist and gynecologist to be aware of this diagnosis as delay in recognition can have serious consequences including patient death.

Catatonia secondary to anti-N-methyl-D-aspartate receptor (NMDAr) encephalitis: a review

“…Titers are effectively reduced by these immunomodulatory treatments. 125 Voice et al 126 described the case of a 17-year-old with anti-NMDAr encephalitis with catatonic symptoms which resolved when all 3 first-line measures were combined after tumor resection (left ovarian teratoma), as was the case with the 19-year-old woman treated by Gulyayeva et al 71 (also an ovarian teratoma). Chatterjee et al 92 described a patient who improved, catatonic symptoms included, with methylprednisolone and plasmapheresis, as did the patient described by Mythri et al, 127 with immunotherapy only.…”

Anti-N-methyl-D-aspartate receptor encephalitis associated with mediastinal teratoma: a rare case report and literature review

“…However, the non-specific and diverse symptoms often lead to misdiagnosis of the disease (11). Definitive diagnosis is established by detection of anti-NMDAR antibodies in CSF and/or serum (13,14). In our case, the patient exhibited prodromal flu-like symptoms, psychiatric and neurologic symptoms and no signs of meningitis; samples of CSF showed moderate increase of lymphocyte.…”

Urinary incontinence as a possible signal of neuromuscular toxicity during immune checkpoint inhibitor treatment: Case report and retrospective pharmacovigilance study

“…Meanwhile, other neuromuscular irAEs could theoretically cause lower urinary tract dysfunction based on the characteristics of the primary disease. For example, autoimmune encephalitis could present with bladder dysfunction ( 19 , 20 ). Diabetic peripheral neuropathy may be associated with urinary incontinence, which manifested as urge incontinence ( 5 ).…”