A Nine-Year Diagnostic Odyssey of Refractory Psychiatric Symptoms Resolving After Resection of a CA19-9-Producing Ovarian Teratoma: A Case Report and Literature Review.

BACKGROUND

Ovarian teratomas are increasingly recognized as triggers for autoimmune processes, including neuropsychiatric syndromes. This report describes a rare case of isolated autoimmune psychosis associated with an ovarian teratoma and reviews the relevant literature.

CASE PRESENTATION: A 15-year-old female with a 9-year psychiatric history was initially diagnosed with schizophrenia. Her symptoms, refractory to multiple antipsychotic regimens, included emotional instability, impulsive aggression, and perceptual abnormalities. Abdominal ultrasonography revealed a giant ovarian teratoma with significantly elevated CA19-9. Histopathology confirmed neural tissue. Following tumor resection, her psychiatric symptoms resolved dramatically, enabling a return to normal schooling.

LITERATURE REVIEW: Our systematic review identified 32 cases of teratoma-associated psychosis. Notably, only 2 cases (7.7%) presented without encephalitic features, with one being seronegative for NMDA antibodies. This highlights the exceptional nature of our "pure" psychiatric presentation.

CONCLUSIONS

Ovarian teratomas may be associated with suspected cases of isolated autoimmune psychosis, even in the absence of typical neurological signs or positive autoantibodies. In such instances, CA19-9 elevation could serve as a nonspecific clue. Comprehensive imaging remains crucial for patients with atypical, treatment-resistant psychosis to avoid diagnostic delays.