A case of anti-NMDAR encephalitis presented hypotensive shock during plasma exchange

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• 作者：Akihiko Miyauchi^a ; Yukifumi Monden^a ; ^{mon4441977319@jichi.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Hitoshi Osaka^a ; Yukitoshi Takahashi^b ; Takanori Yamagata^a
• 关键词：Anti-NMDAR encephalitis ; Plasmapheresis ; Autonomic instability ; Rituximab ; Cyclophosphamide
• 刊名：Brain and Development
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：38
• 期：4
• 页码：427-430
• 全文大小：780 K

文摘

We are reporting on a case of pediatric anti-NMDAR encephalitis with autonomic instability. The patient showed little response to first-line treatment of steroid and IVIG. We initiated plasma exchange, also a first-line treatment. This worsened his autonomic instability, resulting in hypotensive shock. He responded well to rituximab and cyclophosphamide, second-line therapies.

Anti-NMDAR encephalitis is often accompanied by autonomic instability. Our and other reported cases, raise the question of plasma exchange as a first-line therapy for pediatric NMDAR encephalitis, which is frequently accompanied by autonomic instability. Plasma exchange should be performed cautiously in such patients.