Ovarian Teratoma Associated with Coexisting Anti-N-Methyl-D-Aspartate Receptor and Glial Fibrillary Acidic Protein Autoimmune Meningoencephalitis in an Adolescent Girl: A Case Report

Alexandra L Martin; Evan Jolliffe; S Paige Hertweck

doi:10.1016/j.jpag.2017.12.009

Ovarian Teratoma Associated with Coexisting Anti-N-Methyl-D-Aspartate Receptor and Glial Fibrillary Acidic Protein Autoimmune Meningoencephalitis in an Adolescent Girl: A Case Report

J Pediatr Adolesc Gynecol. 2018 Jun;31(3):321-324. doi: 10.1016/j.jpag.2017.12.009. Epub 2017 Dec 30.

Authors

Alexandra L Martin¹, Evan Jolliffe², S Paige Hertweck³

Affiliations

¹ Department of Obstetrics, Gynecology and Women's Health, University of Louisville School of Medicine, Louisville, Kentucky. Electronic address: [email protected].
² Department of Neurology, Mayo Clinic, Rochester, Minnesota.
³ Department of Pediatric and Adolescent Gynecology, Norton Children's Hospital, Louisville, Kentucky.

PMID: 29294378
DOI: 10.1016/j.jpag.2017.12.009

Abstract

Background: Ovarian teratomas are rarely associated with paraneoplastic autoimmune meningoencephalitis. In addition to the well known N-methyl-D-aspartate receptor (NMDA-R) antibody, the glial fibrillary acidic protein (GFAP) antibody is a novel biomarker of autoimmune meningoencephalitis that might be seen in patients with ovarian teratoma.

Case: A 13-year-old girl with acute-onset meningoencephalitis and incidental finding of ovarian teratoma was found to have coexisting anti-NMDA-R and GFAP antibodies present in her cerebrospinal fluid.

Summary and conclusion: NMDA-R and GFAP autoimmune encephalitis should be considered in adolescent patients with neurologic or psychiatric symptoms and an ovarian teratoma. Prompt diagnosis and surgical resection increase the likelihood of full neurologic recovery.

Keywords: Anti-NMDA receptor encephalitis; Autoimmune meningoencephalitis; Glial fibrillary acidic protein (GFAP) meningoencephalitis; Ovarian teratoma.

Publication types

Case Reports

MeSH terms

Adolescent
Anti-N-Methyl-D-Aspartate Receptor Encephalitis / complications*
Anti-N-Methyl-D-Aspartate Receptor Encephalitis / diagnosis
Biomarkers
Female
Glial Fibrillary Acidic Protein / immunology
Humans
Laparoscopy / methods
Meningoencephalitis / complications*
Ovarian Neoplasms / complications*
Ovarian Neoplasms / diagnosis
Ovarian Neoplasms / surgery
Ovary / pathology
Ovary / surgery
Receptors, N-Methyl-D-Aspartate / immunology
Teratoma / complications*
Teratoma / diagnosis
Teratoma / surgery
Ultrasonography / methods

Substances

Biomarkers
Glial Fibrillary Acidic Protein
Receptors, N-Methyl-D-Aspartate

Supplementary concepts

Teratoma, Ovarian