Anti-N-Methyl-Aspartate Receptor Encephalitis in Identical Twin Sisters

Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Ángeles, California, United States
Obstetrics and Gynecology (Impact Factor: 5.18). 01/2014; 123(2). DOI: 10.1097/AOG.0000000000000078
Source: PubMed


Anti-N-methyl-aspartate receptor encephalitis is a potentially fatal form of encephalitis and frequently associated with ovarian teratomas. Surgical removal of ovarian teratomas improves clinical outcome, but it is unclear whether bilateral salpingo-oophorectomy for normal-appearing ovaries is of clinical benefit.
Our report describes a unique clinical scenario of identical twin sisters with anti-N-methyl-aspartate receptor encephalitis. Neither patient responded to immunosuppressive therapy. Imaging studies showed normal-appearing ovaries. The first twin continued on medical therapy only and died of the disease. The second twin underwent a bilateral salpingo-oophorectomy followed by gradual recovery.
Based on our experience in two genetically identical individuals, we suggest considering the removal of normal-appearing ovaries in patients with anti-N-methyl-aspartate receptor encephalitis who fail to respond to medical treatment.

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