A 16-year-old girl presents to the psychiatric emergency department with acute worsening aggression, auditory hallucinations, and suicidal thoughts for the past 10 days. Her medical history is significant for a resected right ovarian teratoma 7 years earlier. Due to escalating combativeness in the emergency department, the psychiatrist administers antipsychotics and anxiolytics, including haloperidol, chlorpromazine, and lorazepam. She is admitted to the psychiatric unit with a diagnosis of acute psychosis and depression.

A few hours later, her neurologic examination findings worsen, with fluctuating mental status and profuse drooling. She is tachycardic (heart rate, 110 beats/min) and hypertensive (blood pressure, 136/81 mm Hg). Her temperature is 98.6ºF (37.0ºC), respirations are 17 breaths/min, and oxygen saturation is 97%. The rest of her physical examination findings are normal. She is transferred to the medical unit for further evaluation.

Head computed tomography, drug screening, and video electroencephalography results are normal. Cerebrospinal fluid (CSF) analysis reveals...

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