利妥昔单抗对最初怀疑为分离性障碍的青春期早期抗N-甲基-D-天冬氨酸受体脑炎有效。
Rituximab Was Effective for Treatment of Anti-N-Methyl-d-Aspartate Receptor Encephalitis in Early Adolescence in Initially Suspected Dissociative Disorder.
作者信息
Shibata Takashi, Kawai Hiroki, Sakamoto Shinji, Tsutsui Ko, Kanbayashi Takashi, Tanaka Keiko, Takaki Manabu
机构信息
Departments of Child Neurology.
Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama.
出版信息
Clin Neuropharmacol. 2021;44(3):99-100. doi: 10.1097/WNF.0000000000000443.
OBJECTIVES
Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is an increasingly recognized etiology of psychiatric symptoms. Because patients with anti-NMDAR encephalitis frequently show aggression, mania, hallucination, depression, or delusion, they are initially diagnosed with schizophrenia or mood disorders. There is only 1 case report of an initially diagnosed dissociative disorder.
METHODS
We obtained consent for the presentation and have not identified individuals for ethical reasons.
RESULTS
We first report an adolescent female patient with anti-NMDAR encephalitis who was initially suspected of having dissociative disorder but was responsive to immunotherapies including rituximab. In this case, her symptoms and electroencephalogram findings were proportional to the antibody titer in the cerebrospinal fluid.
CONCLUSIONS
It is important to consider the possibility of autoimmune encephalitis and immunotherapy including rituximab in cases of not only acute psychosis but also dissociation.
目的
抗N-甲基-D-天冬氨酸受体（NMDAR）脑炎是一种越来越被认可的导致精神症状的病因。由于抗NMDAR脑炎患者经常表现出攻击性、躁狂、幻觉、抑郁或妄想，他们最初常被诊断为精神分裂症或心境障碍。仅有1例最初被诊断为分离性障碍的病例报告。
方法
我们已获得病例展示的同意，且出于伦理原因未提及具体个人信息。
结果
我们首次报告了一名患有抗NMDAR脑炎的青春期女性患者，她最初被怀疑患有分离性障碍，但对包括利妥昔单抗在内的免疫疗法有反应。在该病例中，她的症状和脑电图结果与脑脊液中的抗体滴度成正比。
结论
对于急性精神病以及分离性障碍病例，考虑自身免疫性脑炎的可能性以及包括利妥昔单抗在内的免疫疗法很重要。
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