Background: Anti-NMDA receptor encephalitis (NMDAR-E) is an autoimmune encephalitis (AE) mainly affecting young females. It typically presents with isolated psychiatric symptoms (e.g. depressed mood) at first and neurological abnormalities (e.g. seizures, movement disorders) only develop later. Thus, there is a high risk of overlooking NMDAR-E in patients with preexisting psychiatric illness due to symptom overlap in the prodromal period of the disease when treatment is most effective. Although rare, concomitant or sequential development of a demyelinating disorder is increasingly recognized as an associated disease entity (overlap syndrome), with immediate diagnostic and therapeutic implications. Case presentation: We report a patient with a borderline personality disorder (BPD), which developed NMDAR-E and an overlapping demyelinating disorder with anti-Myelin oligodendrocyte glycoprotein (MOG) -IgG positivity. The initial clinical presentation with predominantly affective symptoms (e.g. mood lability, anxiety, depressed mood) lead us to suspect an exacerbation of the BPD at first. However, acute changes in premorbid behavior, newly developed psychotic symptoms and memory deficits lead us to the correct diagnosis of an AE, which was further complicated by the development of a demyelinating disorder. As a result of impaired illness awareness and psychosis, diagnostic and treatment was difficult to carry out. The symptoms completely remitted after treatment with methylprednisolone 1 g daily for 5 days and 5 cycles of plasma exchange. Conclusions: Continuous awareness for neuropsychiatric clinical warning signs in patients with a pre-diagnosed psychiatric disorder is important for a timely diagnosis. Therefore, we believe that the diagnostic and therapeutic algorithm provided here, for the first time specifically addressing patients with preexisting psychiatric illness and integrating overlap syndromes, can be a useful tool. Moreover, in order to timely perform diagnostics and treatment, judicial approval should be obtained rapidly.

Le cancer du foie est la deuxième cause de mortalité due au cancer dans le monde, avec près de 83% des cas et 84% des décès ayant lieu dans les pays en voie de développement. Le type histologique de cancer du foie le plus fréquemment répandu est le carcinome hépatocellulaire (HCC). Selon la littérature disponible, le HCC affecte électivement des sujets masculins de plus de 50 ans ayant développé préalablement une cirrhose hépatique. Nos objectifs étaient donc i) de confirmer au niveau moléculaire la singularité du HCC chez les patients péruviens, ii) d'évaluer les stratégies d'intervention chirurgicale dans le contexte clinique iii) d'étudier les pratiques de médecine traditionnelle, complémentaire et alternative (TCAM) chez les patients iv) d'étendre cette étude à d'autres pays en développement afin d'obtenir une vision plus globale de la problématique liée au cancer du foie. Nous avons montré que le HCC péruvien présentait un spectre de mutations unique. De plus, nous avons démontré que les arbres décisionnels thérapeutiques développés jusqu'alors ne sont pas adaptés au contexte clinique rencontré au Pérou, et qu'ils sont susceptibles d'être réévalués afin d'augmenter la proportion de patients pouvant être candidats à une intervention chirurgicale. Nous avons caractérisé le fait que la majorité des patients avec un HCC a recours à la phytothérapie de manière complémentaire et alternative. Enfin, nous avons réalisé une étude d'épidémiologie clinique préliminaire sur le cancer du foie au Cambodge. Nous avons décrit une situation clinique distincte de celle rencontrée au Pérou, mais qui nécessite également des recherches scientifiques et cliniques plus approfondies. / Liver cancer is the second leading cause of cancer related death in the world. About 83% of liver cancer cases occur in the developing world. The preeminent histotype of liver cancer is hepatocellular carcinoma (HCC). According to the relevant literature, HCC is defined by patient profile corresponding grossly to cirrhotic males over 50 years old. The aims of the present work were thus to i) confirm at the molecular level the pecularity of Peruvian HCC; ii) evaluate the surgical intervention strategies for HCC in the clinical context encountered in Peru; iii) study the practices of traditional, complementary and alternative medicine ( TCAM) among patients; iv) widen the study to other low- and middle income countries in order to provide deeper insights on liver cancer. We found that Peruvian HCC displayed a unique mutation spectrum. Furthermore, we demonstrated that current therapeutic algorithms for liver cancer are not suited to the clinical context found in Peru. These therapeutic algorithms should be reevaluated in order to increase the number of patients who could be eligible for surgical intervention. Moreover, we characterized the fact that the majority of Peruvian HCC patients rely on phytotherapy in a complementary and alternative way. Finally, we undertook a preliminary clinical, epidemiological study on liver cancer in Cambodia. We delineated a clinical context distinct from the one described in Peru that also requires further clinical and scientific investigation.