Ovarian teratoma masquerading as encephalitis in an adolescent

Abstract

To the Editor: Ovarian teratomas are the most common germ cell neoplasm and, inmany series, themost common excised ovarian neoplasm. Teratomas are often found incidentally, as most are asymptomatic. N-Methyl-daspartate receptor antibody encephalitis (NMDAR-E) is an autoimmune/paraneoplastic syndrome recognized as a frequent cause of encephalitis among young women.1,2 In adults, NMDAR-E is a paraneoplastic manifestation of an ovarian teratoma in nearly 50% of cases; however, this association is rare in children.1 A 17-year-old Hispanic female with a history of depression, anxiety, and self-cutting presented with a 2-week history of altered mental status and seizure-like activity. Her mother noted that 4 weeks prior to symptom onset her father was murdered and her grandfather was diagnosed with cancer. The patient reported an “out of body experience,” and developed intermittent episodes of anxiety, giddiness, agitation, left sided paresthesias, decreased appetite, weight loss, and auditory and visual hallucinations with paranoid ideation. A week into the disease process, she experienced two seizure-like episodes for which she was hospitalized. On examination, she was afebrile with episodes of disorganized thoughts and visual and auditory hallucinations. Complete blood counts and comprehensive chemistry were normal; urine toxicology screen and pregnancy test were