Open Access, Peer-reviewed
pISSN 1015-4817
eISSN 2289-0963
    J Korean Neuropsychiatr Assoc. 2015 Nov;54(4):596-599. Korean.
    Published online Nov 30, 2015.
    https://doi.org/10.4306/jknpa.2015.54.4.596
    Copyright © 2015 Korean Neuropsychiatric Association
    Case Report

    A Case of Paraneoplastic Limbic Encephalitis Presented with Schizophrenic Symptoms

    Kyu Sik Shin, MD,1 Eun Jin Cheon, MD,2 and Se-Jin Lee, MD, PhD1
      • 1Department of Neurology, College of Medicine, Yeungnam University, Daegu, Korea.
      • 2Department of Psychiatry, College of Medicine, Yeungnam University, Daegu, Korea.
    • Address for correspondence: Se-Jin Lee, MD, PhD. Department of Neurology, College of Medicine, Yeungnam University, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, Korea. Tel +82-53-620-3683, Fax +82-53-627-1688, Email: sejinmayo@ynu.ac.kr
    Received July 02, 2015; Revised August 13, 2015; Accepted August 18, 2015.

    Abstract

    Paraneoplastic limbic encephalitis associated with ovarian teratoma has variable clinical manifestations, including hallucination, abnormal behavior, amnesia, mental change, fever, chorea and dystonia, and often has antibodies to N-methyl-D-aspartate receptor (NMDAR), however cases without tumor or antibodies to NMDAR have also been reported. Here, we describe a 35-year-old female who was initially misdiagnosed as schizophrenia because she presented with acute onset of psychiatric symptoms, including visual hallucination, abnormal behavior, confusion, and memory impairment. Three days after admission, she developed high fever refractory to antibiotics. Brain MRI and examination of cerebrospinal fluid were normal. Computerized tomography of the pelvis showed an ovarian teratoma. The patient showed complete improvement after surgical removal of the ovarian teratoma and steroid therapy. We suggest that physicians should consider the possibility of paraneoplastic limbic encephalitis in patients who present with acute onset of psychiatric symptoms with high fever or movement disorder.

    Keywords
    Limbic encephalitis; Paraneoplastic; Ovarian teratoma; Schizophrenia

    Figures

    Fig. 1
    The initial brain MRI of the patient. The axial fluid attenuation inversion recovery imaging shows no abnormalities.

    Fig. 2
    Pelvic CT of the patient. Pelvic CT demonstrates 5.5 cm sized cystic mass lesion containing calcification and fat in the right adnexa (arrow).

    Notes

    Conflicts of Interest:The authors have no financial conflicts of interest.

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    MeSH Terms
    Adult
    Amnesia
    Anti-Bacterial Agents
    Antibodies
    Brain
    Cerebrospinal Fluid
    Chorea
    Dystonia
    Female
    Fever
    Hallucinations
    Humans
    Limbic Encephalitis*
    Magnetic Resonance Imaging
    Memory
    Movement Disorders
    N-Methylaspartate
    Pelvis
    Schizophrenia
    Teratoma
    Metrics
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