Case Report on Acute Psychosis Due to Anti-NMDAR Encephalitis

Shabana Ahamed, Harin Karunajeewa

Western Health, Melbourne, Australia.

DOI: 10.4236/ojim.2014.41005                

Abstract

A 32-year-old female with depression on treatment, was presented with acute psychosis, behavioural symptoms, autonomic instability and a prodromal illness. This occurred on a background of a strong family history of schizophrenia. Despite escalating doses of anti-psychotics, she failed to improve. Her CSF showed a lymphocytic pleocytosis and confirmed the presence of anti-NMDAR antibodies. Following treatment with immunotherapy and excision of her underlying ovarian tumour, she showed a dramatic and seemingly full recovery of her psychotic symptoms. She was weaned off all medications with no residual symptoms. Clinician awareness is important to treat this uncommon but potentially reversible condition.

Keywords

Psychosis; Ovarian Teratoma; Encephalitis

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Dalmau, J., Lancaster, E., Martinez-Hernandez, E., Rosenfeld, M.R. and Balice-Gordon, R. (2011) Clinical Experience and Laboratory Investigations in Patients with Anti-NMDAR Encephalitis. The Lancet Neurology, 10, 63.
[2]	Florance, N.R., Davis, R.L., Lam, C., et al. (2009) Anti-N-methyl-Daspartate Receptor (NMDAR) Encephalitis in Children and Adolescents. Annals of Neurology, 66, 11-18. http://dx.doi.org/10.1002/ana.21756
[3]	Iizuka, T., Sakai, F., Ide, T., et al. (2008) Anti-NMDA Receptor Encephalitis in Japan: Long-Term Outcome without Tumor Removal. Neurology, 70, 504-511. http://dx.doi.org/10.1212/01.wnl.0000278388.90370.c3
[4]	Zalel, Y., Piura, B., Elchalal, U., Czernobilsky, B., Antebi, S. and Dgani, R. (1996) Diagnosis and Management of Malignant Germ Cell Ovarian Tumours in Young Females. International Journal of Gynecology & Obstetrics, 55, 1-10.
[5]	Dalmau, J., Gleichman, A.J., Hughes, E.G., et al. (2008) Anti-NMDA-Receptor Encephalitis: Case Series and Analysis of the Effects of Antibodies. The Lancet Neurology, 7, 1091-1098. http://dx.doi.org/10.1016/S1474-4422(08)70224-2
[6]	Dalmau, J., Tuzun, E., Wu, H.Y., et al. (2007) Paraneoplastic Anti-N-Methyl-D-aspartate Receptor Encephalitis Associated with ovarian teratoma. Annals of Neurology, 61, 25-36. http://dx.doi.org/10.1002/ana.21050
[7]	Glaser, C.A., Honarmand, S., Anderson, L.J., et al. (2006) Beyond Viruses: Clinical Profiles and Etiologies Associated with Encephalitis. Clinical Infectious Diseases, 43, 1565-1577. http://dx.doi.org/10.1086/509330
[8]	Redington, J.J. and Tyler, K.L. (2002) Viral Infections of the Nervous System, 2002: Update on Diagnosis and Treatment. Archives of Neurology, 59, 712-718. http://dx.doi.org/10.1001/archneur.59.5.712
[9]	Hinson, V.K. and Tyor, W.R. (2001) Update on Viral Encephalitis. Current Opinion in Neurology, 14, 369-374. http://dx.doi.org/10.1097/00019052-200106000-00017