Abstract Details

Title Anti-NMDA Receptor Encephalitis Associated with Testicular Teratoma in a Patient with Long-Standing Schizophrenia

Topic Autoimmune Neurology

Presentation(s) P9 - Poster Session 9 (11:45 AM-12:45 PM)

Poster/Presentation
Number 8-019

Objective To report a case of anti-NMDA receptor encephalitis in a patient with chronic schizophrenia.

Background Anti-NMDA receptor encephalitis is the most common cause of autoimmune encephalitis and often presents with prominent neuropsychiatric symptoms that may mimic a primary psychiatric disorder. The diagnosis of autoimmune encephalitis may be particularly challenging in patients who have an underlying primary psychiatric disorder such as schizophrenia.

Design/Methods NA

Results A 52 year-old male with a 30 year history of stable schizophrenia presented with subacute onset of worsening auditory and visual hallucinations, emotional lability, mania, and hyper-religiosity over the course of one week despite no recent change in anti-psychotic medications. Given his psychiatric history, his decompensation was initially attributed to his underlying schizophrenia. However, further work-up revealed the presence of a testicular mass concerning for malignancy, prompting orchiectomy and diagnostic evaluation for a paraneoplastic encephalitis. CT of the head was unremarkable. MRI of the brain was not obtained due to the presence of retained bullet fragments. CSF analysis revealed normal cell count, protein, glucose, and infectious workup. EEG revealed abundant right temporal lobe epileptiform discharges. Given the subacute onset of worsening neuropsychiatric symptoms in the setting of a suspected malignancy and focal epileptiform discharges, empiric treatment for autoimmune encephalitis was initiated with high-dose steroids and intravenous immunoglobulin. Ultimately, autoantibody testing returned positive for NMDA receptor antibodies by cell-based assay in both serum (>1:160 titer) and CSF (1:80 titer). Histological analysis of the testicular mass was consistent with post-pubertal testicular teratoma.

Conclusions Anti-NMDA receptor encephalitis may develop in patients with primary psychiatric disorders and a high index of suspicion should be maintained if the clinical presentation and ancillary testing is compatible with autoimmune encephalitis. Our case also highlights the rare association between testicular teratoma and NMDA receptor encephalitis.

Authors/Disclosures
Cara Cavarretta PRESENTER	Miss Cavarretta has nothing to disclose.
Anup Sonti, MD	Dr. Sonti has nothing to disclose.
Pravesh Saini, MD (LAC + USC Keck Medical Center)	Dr. Saini has nothing to disclose.
Nuriel Moghavem, MD (Los Angeles General Medical Center)	Dr. Moghavem has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Multiple Sclerosis Association of America. Dr. Moghavem has a non-compensated relationship as a Committee Member with National Multiple Sclerosis Society that is relevant to AAN interests or activities. Dr. Moghavem has a non-compensated relationship as a Board Member with Los Angeles County Medical Association that is relevant to AAN interests or activities.
Masoud Majed, MD	Dr. Majed has nothing to disclose.
Rumyar V. Ardakani, MD	Dr. Ardakani has nothing to disclose.

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