Anti-
NMDA receptor (NMDAR)
encephalitis is a recently identified autoimmune disorder with prominent psychiatric symptoms. Patients usually present with acute behavioral change,
psychosis, catatonic symptoms,
memory deficits,
seizures,
dyskinesias, and autonomic instability. In female patients an
ovarian teratoma is often identified. We describe a 32-year-old woman who presented with acute
psychosis. Shortly after admission, she developed
generalized seizures and deteriorated into a catatonic state. Although ancillary tests including MRI, electroencephalogram, and cerebrospinal fluid (CSF) analysis were unremarkable, the presentation of acute
psychosis in combination with recurrent
seizures and a relentless course suggested
autoimmune encephalitis. The patient underwent pelvic ultrasound which disclosed a
dermoid cyst and which led to an urgent
cystectomy.
Plasmapheresis was then initiated, yielding partial response over the next two weeks. Following the detection of high titers of anti-NMDAR
antibodies in the CSF, the patient ultimately received second line immunosuppressive treatment with
rituximab. Over several months of
cognitive rehabilitation a profound improvement was eventually noted, although minor anterograde
memory deficits remained. In this report we call for attention to the inclusion of
anti-NMDAR encephalitis in the differential diagnosis of acute
psychosis. Prompt diagnosis is critical as early
immunotherapy and
tumor removal could dramatically affect outcomes.