title: A case of anti-NMDAR encephalitis presented hypotensive shock during plasma exchange.
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.affiliation: Department of Pediatrics, Jichi Medical University, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Miyauchi
authors.affiliation: Department of Pediatrics, Jichi Medical University, Japan. Electronic address: mon4441977319@jichi.ac.jp.
authors.forename: Yukifumi
authors.initials: Y
authors.lastname: Monden
authors.affiliation: Department of Pediatrics, Jichi Medical University, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Osaka
authors.affiliation: National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan.
authors.forename: Yukitoshi
authors.initials: Y
authors.lastname: Takahashi
authors.affiliation: Department of Pediatrics, Jichi Medical University, Japan.
authors.forename: Takanori
authors.initials: T
authors.lastname: Yamagata
mesh_terms: D060426:Anti-N-Methyl-D-Aspartate Receptor Encephalitis / Q000150:complications / Q000473:pathology / Q000628:therapy*; D001921:Brain / Q000473:pathology; D002648:Child; D003520:Cyclophosphamide / Q000627:therapeutic use; D006801:Humans; D007022:Hypotension / Q000150:complications; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007167:Immunotherapy; D008297:Male; D010951:Plasma Exchange / Q000009:adverse effects*; D010956:Plasmapheresis / Q000009:adverse effects; D000069283:Rituximab / Q000627:therapeutic use; D012769:Shock / Q000150:complications; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D000069283:Rituximab; D003520:Cyclophosphamide
keywords: Anti-NMDAR encephalitis; Autonomic instability; Cyclophosphamide; Plasmapheresis; Rituximab