A 21-year-old nulligravid woman presents to the office reporting three months of dull and aching right lower quadrant pain. She rates the pain a 4 out of 10. She denies any associated nausea, vomiting, or changes in bowel or bladder function. She is sexually active with one male partner and uses condoms for contraception. She has no significant past medical or surgical history. She is not taking medications and she has no known drug allergies.

The gynecology service is consulted on a 16-year-old gravida 0 admitted to the inpatient psychiatric service to rule out physiologic concerns of acute psychosis. On day 2 of her admission, she had a witnessed grand mal seizure. EEG was performed and demonstrated slow delta waves in the frontal temporal area. An MRI showed no abnormalities and a lumbar puncture revealed lymphocytic pleocytosis and was positive for N-methyl-D-aspartate receptor (NMDAR) antibodies. Her last menstrual period was two weeks ago. She has never been sexually active. She has no past medical or surgical history. Her parents deny concern for alcohol, drug use or ingestion, or tobacco use. She is not taking any medications and has no known drug allergies.