This case series aims to describe and characterize the clinical course, progression, treatment and recovery of anti-NMDAR encephalitis during pregnancy due to an ovarian teratoma.  

Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is an autoimmune disease occurring in 1 in 1.5 million people per year that presents with limbic encephalitis. Despite the increase in case reports about novel presentations of the disease, there exists 39 reported cases of anti-NMDAR encephalitis in pregnant women and 17 reported cases in the same population with ovarian teratoma. This begets a limited understanding of the maternal and perinatal outcomes associated with the disease.

Retrospective chart review was conducted on two pregnant patients. Case 1 is a 36 y.o. G5P4 presenting at 17 weeks gestation with acute onset delirium and encephalopathy post-surgical repair for a gunshot wound to the abdomen. Case 2 is a G2P1 26 y.o. patient presenting to the emergency room at 12 weeks gestation with acute onset paranoia and behavioral disturbances.

For case 1, the patient had previous imaging of a right ovarian dermoid cyst with subsequent cerebrospinal fluid (CSF) titer of 1:32 for NMDAR antibodies. Treatment included steroids and a right oophorectomy with stable discharge home at 26 weeks and vaginal delivery at 35 weeks to a healthy infant. Case 2 had an EEG indicating temporal lobe seizures, an antibody CSF titer of 1:80 for NMDAR antibodies and an MRI revealing a right adnexal cyst. She was treated with IVIG, steroids, a right oophorectomy as well as rituximab. Despite treatment, the patient sustained a CSF titer of 1:128 and impaired cognitive function but successfully delivered via repeat cesarean section at 37 weeks.

This case indicates that anti-NMDAR encephalitis during pregnancy due to an ovarian teratoma can have stable maternal and fetal outcomes.