Combined Therapy for Anti-N-methyl D-aspartate Receptor Encephalitis

Background anti-n-methyl- d-aspartate receptor (anti-nmdar) encephalitis is an autoimmune neurological disorder that usually occurs as a paraneoplastic syndrome and is particularly associated with ovarian teratoma. standard therapy for severe cases is not established and the prognosis in patients who do not respond to first-line treatment is poor. case report an 11-year-old boy complained psychiatric symptoms and rapidly lost consciousness. ct scan revealed mediastinal teratoma and serum/spinal fluid was positive for anti-nmdar antibody. he kept comatose and his brain stem function was profoundly disturbed. his symptoms were refractory to first-line therapy, which involved tumor resection, methylprednisolone (mpsl) pulse, intravenous immunoglobulin (ivig), and plasma exchange. we administered a combination therapy of rituximab and cyclophosphamide as second-line therapy and achieved complete recovery without adverse effects related to treatment. conclusion we consider early intensive treatment with a combination of rituximab and cyclophosphamide to be a safe and effective option for severe cases of anti-nmdar encephalitis.