SHM Converge Scientific Abstract ePoster Gallery-Avoiding the Automatic: A Curious Case of Pediatric Encephalopathy

Pdf Summary

This case describes a 17-year-old girl who developed progressive encephalopathy over several weeks, initially with presyncope, anorexia, hypersomnolence, polyuria, and unusual pressured speech. Because history was limited and she had recently used marijuana, her symptoms were repeatedly attributed to substance-related or psychiatric causes, and she was discharged from the ED multiple times before the correct diagnosis was made.<br /><br />Her condition worsened, with urinary incontinence, reduced oral intake, weakness, hypothermia, and decreased consciousness. Initial labs, toxicology, CT head, and infectious studies were unrevealing, though EEG showed generalized rhythmic delta activity consistent with encephalopathy. CSF later revealed pleocytosis and hypoglycorrhachia without evidence of infection, raising concern for autoimmune encephalitis. She was treated empirically with broad antimicrobials, then high-dose steroids when autoimmune disease was suspected.<br /><br />Because of poor response to steroids and ongoing neurologic decline, pelvic imaging was obtained and identified a left ovarian dermoid cyst/teratoma. Surgical resection confirmed teratomatous tissue. Anti-NMDA receptor IgG later returned positive, establishing the diagnosis of anti-NMDA receptor encephalitis secondary to an ovarian teratoma. She subsequently required plasmapheresis, IVIG, and rituximab, with gradual improvement.<br /><br />The case highlights several teaching points: anti-NMDA receptor encephalitis is a common autoimmune encephalitis in young females, often associated with ovarian teratoma; subacute psychiatric symptoms plus neurologic signs should prompt evaluation for encephalitis; and limited history or recent substance use can delay diagnosis through premature psychiatric closure. Early pelvic ultrasound and broad medical differential are essential in adolescents with altered mental status.

Asset Subtitle

Landys Z. Guo

Meta Tag

Author List Anthony Jeck, Landys Z. Guo, Taylor J. Kulik

Category Clinical Vignettes

Concept Anti-NMDA Receptor Encephalitis

Concept Altered Mental Status

Concept Psychiatric Symptoms

Concept Neurologic Symptoms

Concept Ovarian Teratoma

Distinguished Non-Finalist

Presenter Organization University of Kentucky

Presenting Author Landys Z. Guo

Track Pediatric

Keywords

anti-NMDA receptor encephalitis

ovarian teratoma

autoimmune encephalitis

adolescent female

altered mental status

psychiatric symptoms

encephalopathy

cerebrospinal fluid pleocytosis

plasmapheresis

rituximab

Anti-NMDA Receptor Encephalitis

Altered Mental Status

Psychiatric Symptoms

Neurologic Symptoms

Ovarian Teratoma