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Fever of Unknown Origin: An Unusual Presentation of Anti-N-Methyl-D-Aspartate Receptor Encephalitis.

Hur J - Infect Chemother (2015)

Bottom Line: Encephalitis associated with antibodies to the N-methyl-D-aspartate receptor (NMDAR) has variable clinical manifestations.The patient improved dramatically after removal of the teratoma and administration of corticosteroid therapy.When confronted with a young woman with uncontrolled fever and acute psychiatric symptoms, physicians should suspect anti-NMDAR encephalitis.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea.

ABSTRACT
Encephalitis associated with antibodies to the N-methyl-D-aspartate receptor (NMDAR) has variable clinical manifestations. Patients are often diagnosed with infectious processes because of prodromal symptoms and autonomic manifestations. Approximately 70% of patients have prodromal symptoms consisting of headache, fever, nausea, vomiting, and diarrhea, along with frequent autonomic manifestations, including tachycardia, and fluctuating blood pressure. A 36-year-old woman presented with uncontrolled fever and skin and soft tissue infections. She had shown psychiatric symptoms and abnormal behavior, and had been diagnosed with bipolar disorder. Antibodies to NMDAR were positive in cerebrospinal fluid (CSF) and serum samples, and pelvic computed tomography detected a large ovarian teratoma. The patient improved dramatically after removal of the teratoma and administration of corticosteroid therapy. When confronted with a young woman with uncontrolled fever and acute psychiatric symptoms, physicians should suspect anti-NMDAR encephalitis.

No MeSH data available.


Related in: MedlinePlus

About 5.5 cm sized mixed density mass lesion is seen in right adnexa (arrow).
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Figure 1: About 5.5 cm sized mixed density mass lesion is seen in right adnexa (arrow).

Mentions: The patient's fever and abnormal behavior continued, so her CSF was tested on day 21 of her hospitalization. The CSF pressure was 10 cm H2O, proteins were 26.19 mg/dL, sugar was 78 mg/dL, and white blood cells were 2/mm3 (lymphocytes 100%). There were no red blood cells. A pelvic CT on day 26 of the hospitalization found a 5.5 cm mixed density in the right adnexa, which was mixed with a 2.5 × 1.3 cm cyst, adipose tissues, and a calcified area (Fig. 1). The patient was diagnosed with anti-NMDAR encephalitis and methylprednisolone (1 g/day) was administered. On day 28, the right adnexa was removed laparoscopically. The tissue findings indicated a mature cystic teratoma. On day 29 of the hospitalization, which was the third day of steroid administration and 2 days after the operation, the patient's fever was alleviated. After 5 days of administration of methylprednisolone, it was changed to dexamethasone (10 mg/day for 14 days). On day 40 of her hospitalization, nonspecific slow waves appeared on the electroencephalogram. On day 46 of her hospitalization, the patient's mini-mental state examination score was 27. She was discharged and her medication was changed to 60 mg of oral prednisolone, which was slowly reduced until it was fully stopped after 4 weeks. At present, she is leading a normal life with no signs of type 1 bipolar disorder, and is under follow up. Antibodies to NMDAR were positive in CSF and serum samples.


Fever of Unknown Origin: An Unusual Presentation of Anti-N-Methyl-D-Aspartate Receptor Encephalitis.

Hur J - Infect Chemother (2015)

About 5.5 cm sized mixed density mass lesion is seen in right adnexa (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4495274&req=5

Figure 1: About 5.5 cm sized mixed density mass lesion is seen in right adnexa (arrow).
Mentions: The patient's fever and abnormal behavior continued, so her CSF was tested on day 21 of her hospitalization. The CSF pressure was 10 cm H2O, proteins were 26.19 mg/dL, sugar was 78 mg/dL, and white blood cells were 2/mm3 (lymphocytes 100%). There were no red blood cells. A pelvic CT on day 26 of the hospitalization found a 5.5 cm mixed density in the right adnexa, which was mixed with a 2.5 × 1.3 cm cyst, adipose tissues, and a calcified area (Fig. 1). The patient was diagnosed with anti-NMDAR encephalitis and methylprednisolone (1 g/day) was administered. On day 28, the right adnexa was removed laparoscopically. The tissue findings indicated a mature cystic teratoma. On day 29 of the hospitalization, which was the third day of steroid administration and 2 days after the operation, the patient's fever was alleviated. After 5 days of administration of methylprednisolone, it was changed to dexamethasone (10 mg/day for 14 days). On day 40 of her hospitalization, nonspecific slow waves appeared on the electroencephalogram. On day 46 of her hospitalization, the patient's mini-mental state examination score was 27. She was discharged and her medication was changed to 60 mg of oral prednisolone, which was slowly reduced until it was fully stopped after 4 weeks. At present, she is leading a normal life with no signs of type 1 bipolar disorder, and is under follow up. Antibodies to NMDAR were positive in CSF and serum samples.

Bottom Line: Encephalitis associated with antibodies to the N-methyl-D-aspartate receptor (NMDAR) has variable clinical manifestations.The patient improved dramatically after removal of the teratoma and administration of corticosteroid therapy.When confronted with a young woman with uncontrolled fever and acute psychiatric symptoms, physicians should suspect anti-NMDAR encephalitis.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea.

ABSTRACT
Encephalitis associated with antibodies to the N-methyl-D-aspartate receptor (NMDAR) has variable clinical manifestations. Patients are often diagnosed with infectious processes because of prodromal symptoms and autonomic manifestations. Approximately 70% of patients have prodromal symptoms consisting of headache, fever, nausea, vomiting, and diarrhea, along with frequent autonomic manifestations, including tachycardia, and fluctuating blood pressure. A 36-year-old woman presented with uncontrolled fever and skin and soft tissue infections. She had shown psychiatric symptoms and abnormal behavior, and had been diagnosed with bipolar disorder. Antibodies to NMDAR were positive in cerebrospinal fluid (CSF) and serum samples, and pelvic computed tomography detected a large ovarian teratoma. The patient improved dramatically after removal of the teratoma and administration of corticosteroid therapy. When confronted with a young woman with uncontrolled fever and acute psychiatric symptoms, physicians should suspect anti-NMDAR encephalitis.

No MeSH data available.


Related in: MedlinePlus