Appearance of anti-NMDAR antibodies after plasma exchange and total removal of malignant ovarian teratoma in a patient with paraneoplastic limbic encephalopathy

BMJ Case Rep. 2011 Mar 24:2011:bcr0220113851. doi: 10.1136/bcr.02.2011.3851.


A 29-year-old female was admitted under section 2 of the mental health act with an acute psychosis. Her condition deteriorated as she developed a fever and worsening hallucinations. Brain imaging was normal but a lumbar puncture revealed a reactive cerebrospinal fluid. A transvaginal ultrasound revealed a left ovarian mass suggestive of a teratoma. A diagnosis of anti-N-methyl-D-aspartic acid receptor (NMDAR) limbic encephalitis was made but the anti-NMDAR antibody was found to be negative. The patient proceeded to a laparoscopic oopherectomy and a 5-day course of plasma exchange. The patient has made a gradual improvement and the anti-NMDAR antibody has since become positive.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis / blood
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis / diagnosis*
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis / etiology
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis / therapy
  • Autoantibodies / blood*
  • Biomarkers / blood
  • Female
  • Humans
  • Ovarian Neoplasms / complications*
  • Ovarian Neoplasms / diagnosis
  • Ovarian Neoplasms / surgery
  • Ovariectomy*
  • Plasma Exchange*
  • Teratoma / complications*
  • Teratoma / diagnosis
  • Teratoma / surgery


  • Autoantibodies
  • Biomarkers

Supplementary concepts

  • Teratoma, Ovarian