Doctors in Sofia Save Two Young Women With Rare Autoimmune Encephalitis Linked to Ovarian Tumour

Doctors from five hospitals in the capital have saved two young women diagnosed with autoimmune encephalitis triggered by a benign ovarian tumour. The condition is rare, potentially life-threatening, but fully reversible with timely diagnosis and treatment.

Its incidence is estimated at around 1–2 cases per million people per year, and only about 1,000 patients have been described in global medical literature.

Following surgery to remove the tumours and intensive treatment, both women have now made a full recovery.

Madlen Dimitrova, patient: “It all started with headaches—nothing more, just a slight fever. Then insomnia appeared; I didn’t sleep for five nights, and we ended up in emergency departments. I don’t remember any of it; everything was told to me afterwards.”

Elina, Madlen’s sister: “The hardest moment was after the operation, when she lost the ability to speak, walk and eat. There was a moment when her gaze was completely empty.”

Desislava Gruycheva, patient: “I was not conscious. My illness was entirely brain-related. I have no memory of my family or anything at all.”

Both patients developed a severe clinical picture, including seizures.

Prof. Dr Atanas Yonkov, Executive Director of Alexandrovska University Hospital: “A rapid response made it possible to assemble a team of doctors who quickly established the link between the severe disturbance of consciousness and encephalitis as a reaction to a tumour in the ovary.”

Prof. Dr Ivan Kostov, Executive Director of Maychin Dom Hospital: “Dermoid cysts originate from embryonic development, from the so-called ectoderm. They can even contain nerve cells. When the body produces antibodies against them, an autoimmune reaction is triggered—meaning the immune system attacks its own nerve cells.”

Assoc. Prof. Yordanka Yamakova, Head of the Intensive Care Clinic at Alexandrovska University Hospital: “Several therapeutic plasma exchange procedures were performed. The patients’ blood was passed through a special filter that removes antibodies attacking the nervous system.”

In one of the cases, viral encephalitis was also diagnosed.

Assoc. Prof. Dr Trifon Valkov, infectious disease specialist at Prof. Ivan Kirov Hospital for Parasitic and Infectious Diseases: “On one hand, an ovarian teratoma was confirmed, which alone can trigger autoimmune encephalitis. On the other, we also detected DNA of a specific herpes virus in the cerebrospinal fluid and blood.”

Prof. Evgenia Vassileva, Head of Intensive Neurological Care at Tsaritsa Yoanna – ISUL Hospital: “The patient spent 24 days in the clinic. Throughout the entire period, we remained by her side and carried out numerous diagnostic procedures.”

The two cases highlight how coordinated teamwork across multiple medical institutions can lead to successful treatment and full recovery.