Failure to improve after ovarian resection could be a marker of recurrent ovarian teratoma in anti-NMDAR encephalitis: a case report

Yuto Uchida,1 Daisuke Kato,1 Yoriko Yamashita,2 Yasuhiko Ozaki,3 Noriyuki Matsukawa1 1Department of Neurology, 2Department of Experimental Pathology, 3Department of Obstetrics and Gynecology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan Abstract: Anti-N-methyl-D-aspart...

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Autores principales:	Uchida Y, Kato D, Yamashita Y, Ozaki Y, Matsukawa N
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2018
Materias:	N-methyl-D-aspartate receptor antibody autoimmune encephalitis refractory recurrence Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/e083213a5e44433cae22bb2ba04daca7
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spelling	oai:doaj.org-article:e083213a5e44433cae22bb2ba04daca72021-12-02T10:06:35ZFailure to improve after ovarian resection could be a marker of recurrent ovarian teratoma in anti-NMDAR encephalitis: a case report1178-2021https://doaj.org/article/e083213a5e44433cae22bb2ba04daca72018-01-01T00:00:00Zhttps://www.dovepress.com/failure-to-improve-after-ovarian-resection-could-be-a-marker-of-recurr-peer-reviewed-article-NDThttps://doaj.org/toc/1178-2021Yuto Uchida,1 Daisuke Kato,1 Yoriko Yamashita,2 Yasuhiko Ozaki,3 Noriyuki Matsukawa1 1Department of Neurology, 2Department of Experimental Pathology, 3Department of Obstetrics and Gynecology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan Abstract: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a type of autoimmune encephalitis that can be paraneoplastic and usually responds to tumor resection and immunotherapy. More than 75% of patients with anti-NMDAR encephalitis fully recover or have only mild sequelae, whereas the remainder experience severe disability. It remains unknown why certain cases have refractory clinical disease courses. We report a case of anti-NMDAR encephalitis with bilateral ovarian teratomas who was refractory to tumor resection and early initiation of immunotherapy. During intensive care, immunohistochemical analyses of her cerebrospinal fluid showed persistently high reactivity of NMDAR antibody over time. Six months after the operation, pelvic computed tomography detected a recurrent ovarian teratoma. After total enucleation of the bilateral ovaries, with significant pathological findings of bilateral mature cystic teratomas, her clinical condition improved rapidly, paralleled by a decrease in anti-NMDAR reactivity. This case illustrates the need to keep considering why extensive treatment fails to influence the disease when we encounter patients with refractory anti-NMDAR encephalitis. Failure to improve after ovarian resection could be a marker of recurrent ovarian teratoma in anti-NMDAR encephalitis. Keywords: N-methyl-D-aspartate receptor, antibody, autoimmune encephalitis, refractory, recurrenceUchida YKato DYamashita YOzaki YMatsukawa NDove Medical PressarticleN-methyl-D-aspartate receptorantibodyautoimmune encephalitisrefractoryrecurrenceNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol Volume 14, Pp 339-342 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	N-methyl-D-aspartate receptor antibody autoimmune encephalitis refractory recurrence Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	N-methyl-D-aspartate receptor antibody autoimmune encephalitis refractory recurrence Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Uchida Y Kato D Yamashita Y Ozaki Y Matsukawa N Failure to improve after ovarian resection could be a marker of recurrent ovarian teratoma in anti-NMDAR encephalitis: a case report
description	Yuto Uchida,1 Daisuke Kato,1 Yoriko Yamashita,2 Yasuhiko Ozaki,3 Noriyuki Matsukawa1 1Department of Neurology, 2Department of Experimental Pathology, 3Department of Obstetrics and Gynecology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan Abstract: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a type of autoimmune encephalitis that can be paraneoplastic and usually responds to tumor resection and immunotherapy. More than 75% of patients with anti-NMDAR encephalitis fully recover or have only mild sequelae, whereas the remainder experience severe disability. It remains unknown why certain cases have refractory clinical disease courses. We report a case of anti-NMDAR encephalitis with bilateral ovarian teratomas who was refractory to tumor resection and early initiation of immunotherapy. During intensive care, immunohistochemical analyses of her cerebrospinal fluid showed persistently high reactivity of NMDAR antibody over time. Six months after the operation, pelvic computed tomography detected a recurrent ovarian teratoma. After total enucleation of the bilateral ovaries, with significant pathological findings of bilateral mature cystic teratomas, her clinical condition improved rapidly, paralleled by a decrease in anti-NMDAR reactivity. This case illustrates the need to keep considering why extensive treatment fails to influence the disease when we encounter patients with refractory anti-NMDAR encephalitis. Failure to improve after ovarian resection could be a marker of recurrent ovarian teratoma in anti-NMDAR encephalitis. Keywords: N-methyl-D-aspartate receptor, antibody, autoimmune encephalitis, refractory, recurrence
format	article
author	Uchida Y Kato D Yamashita Y Ozaki Y Matsukawa N
author_facet	Uchida Y Kato D Yamashita Y Ozaki Y Matsukawa N
author_sort	Uchida Y
title	Failure to improve after ovarian resection could be a marker of recurrent ovarian teratoma in anti-NMDAR encephalitis: a case report
title_short	Failure to improve after ovarian resection could be a marker of recurrent ovarian teratoma in anti-NMDAR encephalitis: a case report
title_full	Failure to improve after ovarian resection could be a marker of recurrent ovarian teratoma in anti-NMDAR encephalitis: a case report
title_fullStr	Failure to improve after ovarian resection could be a marker of recurrent ovarian teratoma in anti-NMDAR encephalitis: a case report
title_full_unstemmed	Failure to improve after ovarian resection could be a marker of recurrent ovarian teratoma in anti-NMDAR encephalitis: a case report
title_sort	failure to improve after ovarian resection could be a marker of recurrent ovarian teratoma in anti-nmdar encephalitis: a case report
publisher	Dove Medical Press
publishDate	2018
url	https://doaj.org/article/e083213a5e44433cae22bb2ba04daca7
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Failure to improve after ovarian resection could be a marker of recurrent ovarian teratoma in anti-NMDAR encephalitis: a case report

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