Anti-NMDA Receptor Encephalitis Initially Misdiagnosed as Psychiatric Illness: Implications for Perioperative and Critical Care Management

Background

Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is a rare autoimmune disorder that may initially present with psychiatric symptoms, making its early recognition challenging.

Case report

We report a 24-year-old female presenting with acute psychosis, behavioral changes, and insomnia, initially treated as a primary psychiatric disorder. She later developed seizures, orofacial dyskinesia, and autonomic dysfunction. CSF analysis revealed strongly positive anti-NMDA receptor antibodies, and pelvic imaging identified a left ovarian teratoma. The tumor was surgically removed and followed by immunotherapy with corticosteroids and IVIG. She achieved complete recovery within six months.

Conclusion

Anti-NMDA receptor encephalitis is a rare but treatable diagnosis that clinicians should consider in young patients with atypical or rapidly progressive psychiatric symptoms. Early recognition leads to the early course of tumor removal and the initiation of immunotherapy, providing optimal outcomes.