Have you ever heard about this new kind of Encephalitis?

After reading Kiera Echols’ Nightmarish Tumor story and watching her video on youtube this morning, these questions keep popping up in my mind. But first, let’s follow Kiera’s story.

Kiera is 22. In early November, she went to the doctor twice, thinking she had the flu. She was feverish and achy with a bad headache. When her parent took her to the hospital, doctors diagnosed her to have meningitis. After spending six days in the hospital she went home and her parent were not prepared for what happened next.

At the same day she went home, she began hallucinating. She complained to her parents that children in the corner of her bedroom were fighting and being too noisy. Doctors there told her parents that Kiera needed to be admitted to a psychiatric unit. But her parent didn’t believe it. There was no family history of schizophrenia or bipolar disorder, which can both cause hallucinations, and she had no signs of mental illness previously.

When they transferred Kiera to the emergency department at Cincinnatti University Hospital, she screamed at her mom to call a priest because she needed an exorcism. She was lunging at people. She was just completely psychotic. Fortunately, within half an hour, doctors told her parents that they suspected Kiera had an unusual form of encephalitis that was causing her hallucinations. While it looked very much like the beginnings of a schizophrenic or bipolar episode, the real culprit wasn’t in her head but a tiny tumor on her left ovary.

I’m glad to watch the video showing Kiera is doing well after going through all these troubles, but these are those unanswered questions that have really bothered me.

  • If a good hospital had to take more than a week to diagnose Kiera, what would happen to other hospitals with lesser status than a teaching hospital as the one that treated Kiera?
  • What about the hospitals in the third world countries?
  • What if a patient with Kiera’s sympton has to be staying in a psychiatric unit? How is this patient going to be treated?

A quick search on the Internet shows that the work of Dalmau J et. al on “Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies” has been widely cited in medical/psychiatric literatures. However, reading the Abstract of Suzuki et.al., from the Department of Psychiatry of my almamater, Hokkaido University, really made me wonder. “Did they describe Kiera Echols’ case in this study?” Please check the Abstract and compare it yourself:

Recently, paraneoplastic encephalitis associated with ovarian teratoma, which predominantly affects young women, has been reported. Its symptoms are severe but often treatment-responsive and reversible. Various psychiatric symptoms occurring shortly after onset are characteristic of this encephalitis. A 22-year-old female who had a fever and common cold-like symptoms presented with short-term memory loss. She was suspected to have viral encephalitis, but the cerebrospinal fluid (CSF) showed no marked change. Shortly after that, she developed delusions and hallucinations and presented with psychomotor excitement. She was suspected of having schizophrenia and admitted to the psychiatry department. However, several days after admission, she showed upper limb convulsion, orofacial dyskinesias, and central hypoventilation and became unresponsive. The results of laboratory tests were within the normal range, and there was no marked elevation of anti-viral antibody titers. Brain imaging was normal, but a solid tumor containing soft tissue and calcified components, probably an ovarian teratoma, was discovered on an abdominal CT scan. Anti-N-methyl-D-aspartate (NMDA) receptor antibody was positive in her CSF and blood serum, and we diagnosed her with “Anti-NMDA receptor encephalitis”. Gamma globulin was very effective, and the ovarian teratoma was removed. Finally, she could be discharged from our hospital without any sequela, and returned to her job. Psychiatrists often encounter encephalitis patients with psychiatric symptoms. If the type of encephalitis is unknown, we should keep this disease in mind.

I have added the boldface to the sentences at the end of the Abstract to emphasize authors’ concern, and hopefully this post will help Kiera’s effort to raise awareness of what made her so ill. Chances are, with the widespread of this information, any patient that being affected by this monster tumor would not be misdiagnosed or received a wrong treatment again. The remaining questions, however, are:

  • How widespread is the problem? The UC Hospital only treated 3 cases so far.
  • How difficult is the test needed to diagnose the problem?
  • How sophisticated are the equipment required to perform the test?
  • How much would it cost to determine if the Anti-NMDA receptor encephalitis is the real cause, and
  • Would it be possible to get it done in a small community hospital far away from University Health Center like the one at CU?

If you are a health care professional, or you have some insights into these subjects, definitely, we would like to hear from you.

Note:

Orofacial or tardive dyskinesias are involuntary repetitive movements of the mouth and face. In most cases, they occur in older psychotic patients who are in institutions and in whom long-term treatment with antipsychotic drugs of the phenothiazine and butyrophenone groups is being carried out.

Teratoma: A tumor consisting of different types of tissue, as of skin, hair, and muscle, caused by the development of independent germ cells.

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