# From Teratoma to Pacemaker: A Rare Case of Anti-N-Methyl-D-Aspartate Receptor (Anti-NMDAR) Encephalitis With Severe Autonomic Instability

## TL;DR

An 18-year-old woman with anti-NMDAR encephalitis and an ovarian tumor experienced severe heart issues requiring a pacemaker, highlighting the need for close cardiac monitoring in such cases.

## Contribution

This case report highlights a rare cardiac complication in anti-NMDAR encephalitis and emphasizes the importance of multidisciplinary care.

## Key findings

- The patient developed severe autonomic instability requiring temporary and permanent pacemaker implantation.
- Anti-NMDAR encephalitis can lead to life-threatening cardiac complications despite immunotherapy and tumor removal.
- Continuous cardiac monitoring is crucial in managing patients with this condition.

## Abstract

We report a rare case of an 18-year-old female patient who presented with fever, altered mental status, and seizures and was diagnosed with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis in the setting of a right ovarian teratoma with high-titer antibodies. Despite immunotherapy and tumor resection, she developed severe autonomic instability characterized by recurrent bradycardia, sinus pauses, and an episode of asystole, necessitating temporary transvenous pacing followed by permanent pacemaker (Boston Scientific, USA) implantation. This case highlights the potential for life-threatening cardiac complications in anti-NMDAR encephalitis and emphasizes the need for continuous cardiac monitoring, timely intervention, and multidisciplinary management.