Successful Treatment of Anti-N-Methyl-D-Aspartate Receptor Encephalitis With Bilateral Ovarian Teratomas Through Three Surgeries Without Loss of Fertility

TL;DR

A woman with a brain inflammation linked to ovarian tumors was successfully treated with three surgeries while preserving her ability to have children.

Contribution

This case demonstrates that multiple surgeries can treat anti-NMDA receptor encephalitis without sacrificing fertility.

Findings

Three surgeries successfully treated a patient with anti-NMDA receptor encephalitis and bilateral ovarian teratomas.

The patient preserved fertility and later gave birth, showing the effectiveness of cystectomy over full ovary removal.

This case highlights a successful alternative to complete ovary removal in treating refractory encephalitis.

Abstract

Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is associated with ovarian teratomas in approximately half of all cases. Surgical removal of these teratomas, combined with immunotherapy, results in rapid improvement in about half of patients. However, the remaining patients exhibit slower improvement and are at risk of severe complications. Additional surgeries may be considered for these patients. Since even microscopic teratomas can contribute to treatment resistance, complete removal of the remaining ovaries is often selected as a surgical approach. However, this approach results in loss of fertility. We report the case of a 28-year-old woman with bilateral ovarian teratomas and a refractory clinical course after initial treatment, including left salpingo-oophorectomy and right cystectomy. She underwent two additional surgeries, one for a residual teratoma and the other for a recurrent teratoma, both involving cystectomies aimed at preserving fertility. She was discharged home a year after admission and gave birth to a baby two years later. Our case is unique in that three surgeries were performed for an anti-NMDA receptor encephalitis patient with teratomas without loss of fertility, and it documents the reproductive outcome of the patient.

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