Abstract Details

Title Anti-N-Methyl-D-Aspartate (NMDA) Encephalitis Associated with Tall-cell Variant Papillary Thyroid Carcinoma

Topic Autoimmune Neurology

Presentation(s) P2 - Poster Session 2 (5:30 PM-6:30 PM)

Poster/Presentation
Number 15-015

Objective N/A

Background Anti-N-methyl-D-aspartate (NMDA) encephalitis is an autoimmune mediated process characterized by psychosis, seizures, dyskinetic movements, and autonomic instability. Almost half of the reported cases are paraneoplastic and are often associated with an ovarian teratoma. There are no reported cases of anti-NMDA encephalitis related to thyroid tumor. We present a case of anti-NMDA encephalitis associated with papillary thyroid carcinoma in a woman who presented with headaches, myalgia and somnolence mimicking meningoencephalitis. Her titers and dyskinesias rapidly improved with tumor removal.

Design/Methods N/A

Results A 29-year old African female presented with fever, headache, myalgia, somnolence and behavioral changes. Initial evaluation was significant for lymphocytic pleocytosis with normal glucose and protein. Her symptoms worsened and she began to have severe encephalopathy, hallucinations, epileptic seizures, and multifocal dyskinesias involving the face and extremities. Infectious work-up was unremarkable. Whole-body CT with contrast and ovarian ultrasound were unremarkable for malignancy. Fluorodeoxyglucose positron emission tomography (FDG-PET) showed a hypermetabolic thyroid nodule. Serum auto-antibodies to the NMDA receptor and thyroid peroxidase were detected. She was treated with intravenous high-dose steroids, plasmapheresis, intravenous immunoglobulin, rituximab with no clinical or serological response. Fine needle aspiration of the nodule revealed papillary thyroid carcinoma. She underwent total thyroidectomy and pathology showed two foci of tall-cell variant papillary thyroid carcinoma. Serological, electrographic and clinical response followed shortly after tumor resection.

Conclusions This is a first reported case of NMDA encephalitis associated with papillary tall-cell thyroid carcinoma. A thorough malignancy screening should be completed for cases of anti-NMDA encephalitis. A whole body FDG-PET study should be considered in these patients to detect occult malignancy.

Authors/Disclosures
Ahmad Mahadeen, MD (University of Mississippi Medical Center) PRESENTER	Dr. Mahadeen has nothing to disclose.
Naresh Mullaguri, MD	Dr. Mullaguri has nothing to disclose.
Christopher R. Newey, DO (Sanford Health)	Dr. Newey has nothing to disclose.
Pravin George, DO (Cleveland Clinic)	Dr. George has nothing to disclose.

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