title: Risks and Benefits of Rituximab in the Treatment of Hashimoto Encephalopathy in Children: Two Case Reports and a Mini Review.
abstract: Hashimoto encephalopathy is a rare condition, characterized by the association of encephalopathy with a variety of neurological symptoms and autoantibodies to the thyroid gland. Its etiology is unknown, and symptoms are usually treated with immune suppressive therapy, e.g., high doses of corticosteroids.
  
  
  
  Here, we report the long-term outcome in two steroid-refractory adolescents with Hashimoto encephalopathy who were treated with rituximab, a monoclonal antibody directed against CD20. In addition, we reviewed the literature regarding treatment strategies in Hashimoto encephalopathy.
  
  
  
  Anti-B-cell therapy can be of value in the treatment of Hashimoto encephalopathy, especially in steroid refractory cases, but side effects due to low levels of immunoglobulins warrant careful monitoring.
authors: Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands.
authors: Annemieke
authors: A
authors: Maas
authors: Department of Pediatric Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands.
authors: Kees P J
authors: KP
authors: Braun
authors: Department of Pediatric Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands.
authors: Karin
authors: K
authors: Geleijns
authors: Department of Pediatric Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands.
authors: Floor E
authors: FE
authors: Jansen
authors: Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands. Electronic address: a.vanroyen@umcutrecht.nl.
authors: Annet
authors: A
authors: van Royen-Kerkhof
mesh_terms: D002648:Child; D004660:Encephalitis / Q000188:drug therapy* / Q000276:immunology; D005260:Female; D050031:Hashimoto Disease / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D008297:Male; D000069283:Rituximab / Q000627:therapeutic use*
chemical_list: D007155:Immunologic Factors; D000069283:Rituximab
keywords: Hashimoto encephalopathy; anti-B-cell therapy; corticosteroid treatment; hypogammaglobulinemia; rituximab