Journal of Yeungnam Medical Science

Yeungnam University College of Medicine, Yeungnam University Institute Medical Science (영남대 의대 학술지 편집위원회)
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Anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma in Korea: three case reports

  • Lee, Jisun (Department of Obstetrics and Gynecology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University) ;
  • Kang, Seongwoo (Department of Obstetrics and Gynecology, Ajou University School of Medicine) ;
  • Chang, Hye Jin (Department of Obstetrics and Gynecology, Ajou University School of Medicine) ;
  • Lee, Yong Hee (Department of Pathology, Ajou University School of Medicine) ;
  • Son, Joo-Hyuk (Gynecologic Cancer Center and Department of Obstetrics and Gynecology, Ajou University School of Medicine) ;
  • Kong, Tae Wook (Gynecologic Cancer Center and Department of Obstetrics and Gynecology, Ajou University School of Medicine) ;
  • Chang, Suk-Joon (Gynecologic Cancer Center and Department of Obstetrics and Gynecology, Ajou University School of Medicine) ;
  • Hwang, Kyung Joo (Department of Obstetrics and Gynecology, Ajou University School of Medicine) ;
  • Kim, Miran (Department of Obstetrics and Gynecology, Ajou University School of Medicine)
  • Received : 2020.10.06
  • Accepted : 2020.12.29
  • Published : 2021.10.31
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Abstract

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a severe autoimmune paraneoplastic syndrome associated with ovarian teratomas. Most patients develop neurologic symptoms, including psychosis, memory deficits, seizures, or abnormal movements, and experience abdominal pain related to ovarian neoplasm. We present a case report of three patients diagnosed with anti-NMDAR encephalitis accompanied by ovarian teratomas at Ajou University Hospital in Korea. The patients demonstrated a different clinical course of the disease. However, upon diagnosis, all patients underwent surgical removal of the ovarian teratoma followed by intensive immunotherapy. The symptoms progressively improved following treatment. This is a case report of a rare autoimmune anti-NMDAR encephalitis associated with ovarian neoplasms, including immature teratoma.

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References

  1. Braverman JA, Marcus C, Garg R. Anti-NMDA-receptor encephalitis: a neuropsychiatric syndrome associated with ovarian teratoma. Gynecol Oncol Rep 2015;14:1-3. https://doi.org/10.1016/j.gore.2015.07.004
  2. Dalmau J, Lancaster E, Martinez-Hernandez E, Rosenfeld MR, Balice-Gordon R. Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. Lancet Neurol 2011;10:63-74. https://doi.org/10.1016/S1474-4422(10)70253-2
  3. Irani SR, Bera K, Waters P, Zuliani L, Maxwell S, Zandi MS, et al. N-methyl-D-aspartate antibody encephalitis: temporal progression of clinical and paraclinical observations in a predominantly non-paraneoplastic disorder of both sexes. Brain 2010;133:1655-67. https://doi.org/10.1093/brain/awq113
  4. Dalmau J, Gleichman AJ, Hughes EG, Rossi JE, Peng X, Lai M, et al. Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies. Lancet Neurol 2008;7:1091-8. https://doi.org/10.1016/S1474-4422(08)70224-2
  5. Dalmau J, Tuzun E, Wu HY, Masjuan J, Rossi JE, Voloschin A, et al. Paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma. Ann Neurol 2007;61:25-36. https://doi.org/10.1002/ana.21050
  6. Yang YW, Tsai CH, Chang FC, Lu MK, Chiu PY. Reversible paraneoplastic limbic encephalitis caused by a benign ovarian teratoma: report of a case and review of literatures. J Neurooncol 2006;80:309-12. https://doi.org/10.1007/s11060-006-9183-4
  7. Kemp JA, McKernan RM. NMDA receptor pathways as drug targets. Nat Neurosci 2002;5(Suppl):1039-42. https://doi.org/10.1038/nn936
  8. Vitaliani R, Mason W, Ances B, Zwerdling T, Jiang Z, Dalmau J. Paraneoplastic encephalitis, psychiatric symptoms, and hypoventilation in ovarian teratoma. Ann Neurol 2005;58:594-604. https://doi.org/10.1002/ana.20614
  9. Florance NR, Davis RL, Lam C, Szperka C, Zhou L, Ahmad S, et al. Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis in children and adolescents. Ann Neurol 2009;66:11-8. https://doi.org/10.1002/ana.21756
  10. Zakhour M, Axtell AE, Lentz SE. Anti-NMDA receptor encephalitis: consider the ovaries. Gynecol Oncol 2015;137(Suppl 1):105. https://doi.org/10.1016/j.ygyno.2015.01.261
  11. Medepalli K, Lee CM, Benninger LA, Elwing JM. Psychosis: call a surgeon? A rare etiology of psychosis requiring resection. SAGE Open Med Case Rep 2016;4:2050313X16670084.
  12. Zhang L, Lu Y, Xu L, Liu L, Wu X, Zhang Y, et al. Anti-N-methyl-D-aspartate receptor encephalitis with accompanying ovarian teratoma in female patients from East China: clinical features, treatment, and prognostic outcomes. Seizure 2020;75:55-62. https://doi.org/10.1016/j.seizure.2019.12.016
  13. Lee CH, Kim EJ, Lee MH, Yim GW, Kim KJ, Kim KK, et al. Anti-N-methyl-D-aspartate receptor encephalitis: a rare complication of ovarian teratoma. J Korean Med Sci 2020;35:e207. https://doi.org/10.3346/jkms.2020.35.e207