Successful multi-disciplinary management of anti-NMDAR encephalitis during pregnancy

Abstract

The comorbid presentation of anti-NMDAR encephalitis with ovarian teratomas was first described in 2005. The incidence of anti-NMDAR encephalitis during pregnancy is rare, with 16 cases reported to date. We describe the case of a 31-year-old nulliparous woman who presented with status epilepticus in early pregnancy and was subsequently diagnosed with anti-NMDAR encephalitis. The inter-hospital transfer was required for higher-level care and ventilation. A comprehensive work-up identified anti-NMDAR antibodies in both serum and cerebrospinal fluid. Pelvic imaging showed a unilateral ovarian cyst, proceeding to right salpingo-oophorectomy and cystectomy of a mature cystic teratoma. Post-operatively, she was admitted to the intensive care unit for two months. Immunotherapy was commenced, and clinical status improved. She recovered well and at 35 weeks and 2 days of gestation delivered a live male infant via uncomplicated caesarean section. We discuss the diagnostic steps and multi-disciplinary management to care for this pregnant patient.