Itagaki Hideya, Hirano Momoka, Endo Tomoyuki
Emergency and Disaster Medicine, Tohoku Medical and Pharmaceutical University Hospital, Sendai, JPN.
Cureus. 2024 Nov 14;16(11):e73713. doi: 10.7759/cureus.73713. eCollection 2024 Nov.
Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an autoimmune encephalitis characterized by psychiatric and neurological symptoms. It often presents as a paraneoplastic manifestation and is rarely associated with small cell lung cancer. While treatment usually involves immunotherapy and treatment of underlying malignancy, the patient's condition can complicate treatment decisions. A 66-year-old man presented to the emergency department with a chief complaint of fever and impaired consciousness. Tests revealed anti-NMDAR encephalitis and small cell lung cancer. Despite immunotherapy, including steroids, intravenous immunoglobulin, and rituximab, chemotherapy was not possible due to the patient's poor condition. Immunotherapy treatment was continued, but there was no improvement in his state of consciousness, and death was confirmed on the 101st day of hospitalization. Anti-NMDAR encephalitis caused by small cell carcinoma is treated with immunotherapy and cancer therapy; only immunotherapy is not enough.
抗N-甲基-D-天冬氨酸受体（抗NMDAR）脑炎是一种以精神和神经症状为特征的自身免疫性脑炎。它常表现为副肿瘤综合征，很少与小细胞肺癌相关。虽然治疗通常包括免疫治疗和潜在恶性肿瘤的治疗，但患者的病情会使治疗决策变得复杂。一名66岁男性因发热和意识障碍为主诉就诊于急诊科。检查发现抗NMDAR脑炎和小细胞肺癌。尽管进行了免疫治疗，包括使用类固醇、静脉注射免疫球蛋白和利妥昔单抗，但由于患者病情不佳，无法进行化疗。免疫治疗持续进行，但患者的意识状态没有改善，住院第101天被确认死亡。小细胞癌引起的抗NMDAR脑炎需采用免疫治疗和癌症治疗；仅免疫治疗是不够的。
