Rozaleen Aleyadeh1, Eduardo Inacio Nascimento Andrade1, Zakir Shaikh1, Abigail Bose1, Raffaella Umeton1
1University of Massachusetts Medical School
Objective:
To present a case series of two patients who developed NMDAR encephalitis after elective abortion.
Background:
Anti-NMDAR encephalitis has been associated with several preceding triggers, most commonly tumors and HSV encephalitis. Recognizing other triggers is important to elevate clinical suspicion when evaluating patients with acute encephalitis symptoms. Although cases have been reported of NMDA encephalitis during pregnancy, to our knowledge only one other case preceded by an abortive procedure was published.
Results:
Two patients, aged 20 and 27 years old, with no previous neurological history developed anti-NMDAR encephalitis after undergoing an elective abortion. Symptoms started 2 weeks after the procedure and was described as an acute psychosis. Diagnosis of anti-NMDAR encephalitis was confirmed with antibody titer testing in the CSF and serum. Both patients had positive Anti-NMDAR antibody titer in CSF; one patient also had positive antibody testing in the serum. Hospital stay of both patients was complicated by catatonia, with one patient requiring prolonged ICU stay due to severe dysautonomia. Patients were treated with a 5-day course of IVIG and made a full recovery. Cancer workup was done with transvaginal ultrasound, and CT chest, abdomen and pelvis on initial presentation and was negative at the time of presentation. In serial CT scans, one of the patients developed a thymoma six months after the onset and underwent surgical removal of the lesion with complete resolution of the symptoms.
Conclusions:
These cases suggests that anti-NMDAR autoimmune encephalitis may be correlated with recent abortion. Recognizing this possible relation might indicate that termination of pregnancy in these patients may not lead to improvement of the neurological condition. It is important to note that this association should not preclude investigations for underlying malignancy. Further population studies need to be performed to confirm abortion as a possible trigger and underlying pathophysiology of this neurological condition.