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.
Different management and outcomes of anti-N-methyl-aspartate receptor encephalitis in identical twins suggest a potential role for oophorectomy.
Department Obstetrics and Gynecology, UCLA David Geffen School of Medicine, Los Angeles, and the Department Obstetrics and Gynecology, Division of Gynecologic Oncology, Stanford School of Medicine, Stanford, California.
Corresponding author: Oliver Dorigo, MD, PhD, Stanford School of Medicine, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, 300 Pasteur Drive, HG332, Stanford, CA 94305-5317; e-mail: firstname.lastname@example.org.
Financial Disclosure The authors did not report any potential conflicts of interest.