PMC5348463_01
The clinical course of the patient. SIMV: synchronized intermittent mandatory ventilation, PS: pressure support, CPAP: continuous positive airway pressure, IVIg: intravenous immunoglobulin, PE: plasma exchange, DFPP: double filtration plasmapheresis, mPSL: methylprednisolone, DVT: deep vein thrombosis
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She was treated with methylprednisolone (mPSL) pulse therapy at a dose of 1 g for 3 days and intravenous immunoglobulin therapy (IVIg) at a dose of 0.4 g/kg for 5 days (Fig. 1). We could not perform further intensive immunosuppressive therapy, such as rituximab and cyclophosphamide, due to repetitive severe infections, including pneumonia and sepsis (Fig. 1). After the fifth IVIg, her involuntary movements and respiratory failure improved gradually, and she was transferred to rehabilitation hospital eight months after onset (Fig. 1).
Electroencephalogram of the patient. Diffuse beta activity superimposed on frontally dominant high-voltage rhythmic delta bursts was observed.
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Electroencephalogram (EEG) demonstrated diffuse beta activity superimposed on frontally dominant high-voltage rhythmic delta bursts, consistent with "extreme delta brush" (Fig. 2).
Brain magnetic resonance image (MRI) of the patient (FLAIR image, axial view). (A) MRI performed at 1 month after onset. High signal intensity and slight swelling were seen in the bilateral medial temporal lobes. (B) MRI performed at 2 years after onset. Abnormal signal intensity in the bilateral medial temporal lobes disappeared without brain atrophy.
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Brain magnetic resonance imaging (MRI) showed slightly increased signal intensity with swelling in the bilateral medial temporal lobes on T2 and FLAIR imaging (Fig. 3A). Neither brain atrophy nor abnormal signals were revealed on MRI (Fig. 3B), but her memory disturbance and mental juvenility persisted even two years after onset.
The radiological and pathological findings of the ovarian teratoma. (A) Computed tomography of the pelvis showed a cystic tumor (1.5 cm in maximal diameter) with small calcifications adjacent to the right ovary. (B) Gross pathology of the encapsulated ovarian teratoma containing hair.
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Abdominal computed tomography (CT) revealed a right ovarian cystic tumor with small calcifications (Fig. 4A). A pathological examination showed a mature cystic teratoma (Fig. 4B) consisting of stratified squamous epithelium with cutaneous appendage, neural tissue with choroid plexus, adipose tissue, bone, cartilage, and intestinal structure with goblet cells.