An Atypical Case of Pancreatic Mass Causing Anti-NMDA Receptor Encephalitis
Sunday, March 6, 2016
South Exhibit Hall H (Convention Center)
Salima A. Thobani, M.D., Marilyn Li, M.D., Kenny Y. Kwong, Lyne G. Scott, MD FAAAAI, Rahim Shiraz Govani, M.D.
Rationale: Anti-N-methyl-D aspartate (NMDA) receptor encephalitis is an autoimmune encephalitis with antibodies against NR1 and NR2 subunits of cell surface NMDARs. Patients’ present with variable clinical features. Anti-NMDA receptor encephalitis is associated with ovarian pathology. Methods: Case Report Results: A 23 year old female with no past medical history was brought to ER for altered mental status. 2 weeks prior to admission(PTA) she was having short-term memory problems. 1 week (PTA) she was agitated with auditory hallucinations. 2 days (PTA) PMD prescribed seroquel. On admission she was acting psychotic, speech was impaired with orofacial dyskinesias.  Utox was negative, CT & MRI were normal. LP demonstrated 50 wbc(96% monocytes) and she was admitted with diagnosis of viral encephalitis. Patient became catatonic and displayed autonomic dysfunction. On Day 5 of hospitalization she was transferred to an academic medical center where she underwent CT chest/abdomen/pelvis, with serum sent to California encephalitis project to evaluate for NMDA receptor antibodies. The CT identified 5x5cm mass at the tail of pancreas. Day 16 of hospitalization, NMDA receptor auto antibodies in her serum were detected. It was the clinical impression pancreatic mass was causing her to have Anti-NMDA receptor encephalitis. The patient underwent surgery and received IVIG for 5 days (2grams/Kg). Neurologically, she immediately improved. Her final pathology was solid-pseudopapillary neoplasm. Conclusions: Anti-NMDA receptor encephalitis was first described in 2007 by Dr. Dalmau.  Aniti-NMDA receptor encephalitis has been associated in some cases with ovarian pathology, in particular teratoma. This case illustrates the first case of NMDA receptor encephalitis due to a pancreatic neoplasm.