Combined Therapy for Anti-N-methyl D-aspartate Receptor Encephalitis

Kido, Takahiro and Kobayashi, Chie and Ohto, Tatsuyuki and Takahashi, Yukitoshi and Sumazaki, Ryo and Fukushima, Takashi (2017) Combined Therapy for Anti-N-methyl D-aspartate Receptor Encephalitis. International Journal of Pediatrics, 5 (9). pp. 5687-5691.

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Abstract

Background Anti-N-methyl- d-aspartate receptor (anti-NMDAR) encephalitis is an autoimmune neurological disorder that usually occurs as a paraneoplastic syndrome and is particularly associated with ovarian teratoma. Standard therapy for severe cases is not established and the prognosis in patients who do not respond to first-line treatment is poor. Case Report An 11-year-old boy complained psychiatric symptoms and rapidly lost consciousness. CT scan revealed mediastinal teratoma and serum/spinal fluid was positive for anti-NMDAR antibody. He kept comatose and his brain stem function was profoundly disturbed. His symptoms were refractory to first-line therapy, which involved tumor resection, methylprednisolone (mPSL) pulse, Intravenous immunoglobulin (IVIG), and plasma exchange. We administered a combination therapy of rituximab and cyclophosphamide as second-line therapy and achieved complete recovery without adverse effects related to treatment. Conclusion  We consider early intensive treatment with a combination of rituximab and cyclophosphamide to be a safe and effective option for severe cases of anti-NMDAR encephalitis.

Item Type: Article
Subjects: WS Pediatrics
QV pharmacology
Divisions: Journals > International J Pediatrics
Depositing User: IJP IJP
Date Deposited: 19 Sep 2017 18:45
Last Modified: 20 Sep 2017 23:10
URI: http://eprints.mums.ac.ir/id/eprint/946

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