ABSTRACT
A severe paraneoplastic form of acute encephalitis associated with antibodies against the N-methyl D-aspartate (NMDA) receptor typically occurs in young individuals and is associated, but not always, with an underlying tumor. If diagnosed early, initiation of immunotherapy and tumor removal (if present) may result in recovery. We report a case in a 25-year-old young woman who presented to our medical center with postpartum psychosis. Treatment with rituximab (a chimeric monoclonal antibody against the protein CD20) resulted in gradual improvement in mental status and resolution of seizure activity episodes. A year after diagnosis and treatment, the patient was doing well without recurrences, and no tumors appeared. This is the first described case of anti-NMDA-receptor antibodies encephalitis that presented initially as a postpartum psychosis disorder and was successfully treated with rituximab.
Subject(s)
Anti-N-Methyl-D-Aspartate Receptor Encephalitis/diagnosis , Antibodies, Monoclonal, Murine-Derived/therapeutic use , Immunologic Factors/therapeutic use , Psychotic Disorders/diagnosis , Adult , Anti-N-Methyl-D-Aspartate Receptor Encephalitis/drug therapy , Anti-N-Methyl-D-Aspartate Receptor Encephalitis/physiopathology , Antigens, CD20/immunology , Female , Follow-Up Studies , Humans , Postpartum Period , Rituximab , Treatment OutcomeABSTRACT
Kodamaea (Pichia) ohmeri is an unusual yeast-form fungus that has recently been identified as an important etiology of fungemia, endocarditis, cellulitis, funguria and peritonitis in immunocompromised patients. We report a case of K. ohmeri fungemia in a 34-year-old hospitalized patient with thrombophlebitis. The patient was admitted to the hospital for evaluation and management of an acquired tracheo-esophageal fistula secondary to an impacted denture. Fever developed on hospital day 22, and physical exam revealed right arm superficial thrombophlebitis at the site of the peripheral venous catheter that was confirmed by Doppler ultrasound. The peripheral vein was removed and blood cultures from hospital day 22 and 23 grew yeast species. The yeast was subsequently identified to be K. ohmeri by Vitek II and API20C and was confirmed by 18S rRNA gene sequencing. The fungemia and right arm phlebitis was successfully treated with a 2-week course of micafungin therapy. This is the first case of K. ohmeri fungemia in a patient that was successfully treated with micafungin.
