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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.

Authors+Show Affiliations

Department of Pediatrics, Jichi Medical University, Japan.Department of Pediatrics, Jichi Medical University, Japan. Electronic address: mon4441977319@jichi.ac.jp.Department of Pediatrics, Jichi Medical University, Japan.National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan.Department of Pediatrics, Jichi Medical University, Japan.

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 -