Case Report

An acutely confused 15-year-old girl

These women presented with an ovarian teratoma and symptoms that included psychiatric manifestations and altered level of consciousness. In both patients, there was a gradual significant improvement in symptoms after tumor removal (Nokura et al., 1997; Okamura et al., 1997). In 2005, a series of four women with ovarian teratoma, psychiatric symptoms, altered level of consciousness and central hypoventilation was described.

In the last few years, prominent psychiatric symptoms (i.e., delusions, hallucinations, and catatonic movement disorder) have been found to be linked to a number of antibodies to neuronal cell surface antigens in cases of anti-NMDA-receptor (NMDAR) encephalitis (Braakman et al., 2010; Dalmau et al., 2008; Irani et al., 2010; Parthasarathi et al., 2006; Vincent et al., 2004; Zandi et al., 2011). These symptoms often occur in young females with ovarian teratomas, who have good responses to tumor surgery and immunotherapy (Dalmau et al., 2007; Kleinig et al., 2008; Nokura et al., 1997; Okamura et al., 1997). There is also evidence that a dysfunction in the activation of the type-1 immune response might be associated with tryptophan/kynurenine metabolism anomalies in schizophrenia (Muller et al., 2012).

Among them, 4 articles were published before 2007 (before the first description of anti-NMDA receptor encephalitis). Typically, the case report published in 1997 concerning a 15-year-old girl with an acute confused state with an immature ovarian teratoma might have been an anti-NMDA receptor encephalitis because she recovered full physical and mental faculties after salpingo-oophorectomy; anti-Yo, anti-Hu, and anti-Ri antibodies were all negative.9 Consequently, misdiagnosis of anti-NMDA receptor encephalitis that complicated ovarian teratoma before 2007 is possible.

However, the severity of this disorder, which may result in death or severe complications, and the reported response to tumor resection and immunotherapy strongly support the use of these treatments [6]. In addition, in previous reports, the surgical method of choice was generally adnexectomy [3,7,8]. Gynecologic surgeons should seriously consider offering patients the option of ovarian conservation.