- Anti-NMDAR encephalitis associated with ovarian teratoma; tumour resection and first-line immunotherapies produced incomplete recovery.
- Patient developed delayed lethargy and upper-limb tremors with reversible bilateral basal ganglia and substantia nigra MRI abnormalities.
- Additional cyclophosphamide resulted in clinical and radiological improvement, suggesting benefit of further immunotherapy for delayed neurological worsening.
Cureus. 2026 Jul 30;18(7):e113647. doi: 10.7759/cureus.113647. eCollection 2026 Jul.
ABSTRACT
Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a neuroinflammatory disorder characterized by a broad spectrum of neuropsychiatric symptoms, and the optimal treatment strategy for atypical or refractory cases has not been well established. We report the case of a 26-year-old woman with anti-NMDAR encephalitis associated with an ovarian teratoma who presented with acute psychiatric and neurological manifestations. The patient underwent tumor resection followed by first-line immunotherapies, including corticosteroids, intravenous immunoglobulin, and plasma exchange. Because of persistent neurological symptoms, second-line immunotherapy with cyclophosphamide was initiated, leading to gradual clinical improvement. However, she subsequently developed lethargy and upper-limb tremors, accompanied by bilateral basal ganglia and substantia nigra abnormalities on MRI. Notably, both her clinical symptoms and radiological abnormalities improved following an additional course of cyclophosphamide treatment. This report highlights a rare clinical and radiological manifestation and suggests that additional immunotherapy may be effective for delayed neurological worsening.
PMID:42668959 | PMC:PMC13525710 | DOI:10.7759/cureus.113647
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