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A case of anti-NMDAR encephalitis presented hypotensive shock during plasma exchange.
Brain Dev. 2016 Apr; 38(4):427-30.BD

Abstract

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.

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Authors+Show Affiliations

Miyauchi A
Department of Pediatrics, Jichi Medical University, Japan.
Monden Y
Department of Pediatrics, Jichi Medical University, Japan. Electronic address: mon4441977319@jichi.ac.jp.
Osaka H
Department of Pediatrics, Jichi Medical University, Japan.
Takahashi Y
National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan.
Yamagata T
Department of Pediatrics, Jichi Medical University, Japan.

MeSH

Anti-N-Methyl-D-Aspartate Receptor EncephalitisBrainChildCyclophosphamideHumansHypotensionImmunosuppressive AgentsImmunotherapyMalePlasma ExchangePlasmapheresisRituximabShockTreatment Outcome

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

26524986

Citation

Miyauchi, Akihiko, et al. "A Case of anti-NMDAR Encephalitis Presented Hypotensive Shock During Plasma Exchange." Brain & Development, vol. 38, no. 4, 2016, pp. 427-30.
Miyauchi A, Monden Y, Osaka H, et al. A case of anti-NMDAR encephalitis presented hypotensive shock during plasma exchange. Brain Dev. 2016;38(4):427-30.
Miyauchi, A., Monden, Y., Osaka, H., Takahashi, Y., & Yamagata, T. (2016). A case of anti-NMDAR encephalitis presented hypotensive shock during plasma exchange. Brain & Development, 38(4), 427-30. https://doi.org/10.1016/j.braindev.2015.10.009
Miyauchi A, et al. A Case of anti-NMDAR Encephalitis Presented Hypotensive Shock During Plasma Exchange. Brain Dev. 2016;38(4):427-30. PubMed PMID: 26524986.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A case of anti-NMDAR encephalitis presented hypotensive shock during plasma exchange. AU - Miyauchi,Akihiko, AU - Monden,Yukifumi, AU - Osaka,Hitoshi, AU - Takahashi,Yukitoshi, AU - Yamagata,Takanori, Y1 - 2015/10/31/ PY - 2015/04/15/received PY - 2015/09/29/revised PY - 2015/10/06/accepted PY - 2015/11/4/entrez PY - 2015/11/4/pubmed PY - 2016/12/15/medline KW - Anti-NMDAR encephalitis KW - Autonomic instability KW - Cyclophosphamide KW - Plasmapheresis KW - Rituximab SP - 427 EP - 30 JF - Brain & development JO - Brain Dev VL - 38 IS - 4 N2 - 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. SN - 1872-7131 UR - https://www.unboundmedicine.com/medline/citation/26524986/A_case_of_anti_NMDAR_encephalitis_presented_hypotensive_shock_during_plasma_exchange_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0387-7604(15)00221-1 DB - PRIME DP - Unbound Medicine ER -