Chen Ying, Li Wanwan, Ni Liping, Mei Yufang, Zhou Yan, Wan Wenbin
Department of Neurology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Front Cardiovasc Med. 2025 Apr 10;12:1574698. doi: 10.3389/fcvm.2025.1574698. eCollection 2025.
Autoimmune encephalitis (AE) is a group of disorders characterized by antibodies targeting neuronal cell surface, intracellular structures and synapse antigens. Treatment for AE involves reducing antibody levels and suppressing immune-mediated inflammation using intravenous immunoglobulin, plasma exchange (PE), and immune-modulating agents. PE is commonly used in autoimmune neurological diseases, but the safety issues of PE are worth continuous attention. This case report describes a 28-year-old patient who was diagnosed with anti-GAD65 AE and underwent treatments including double filtration plasmapheresis (DFPP), steroids, and immunosuppressive agents. However, complications arose when the patient developed thrombosis and was diagnosed with type II heparin-induced thrombocytopenia (HIT). He was treated with an oral anticoagulant and eventually recovered. One month later, follow-up examinations showed no presence of emboli and his epilepsy remained well controlled. There is a risk of HIT, a potentially dangerous adverse reaction to heparin during treatment of PE. The current case highlights the importance of monitoring for HIT during PE and the need for alternative anticoagulants.
自身免疫性脑炎（AE）是一组以针对神经元细胞表面、细胞内结构和突触抗原的抗体为特征的疾病。AE的治疗包括使用静脉注射免疫球蛋白、血浆置换（PE）和免疫调节剂来降低抗体水平并抑制免疫介导的炎症。PE常用于自身免疫性神经疾病，但PE的安全性问题值得持续关注。本病例报告描述了一名28岁的患者，该患者被诊断为抗GAD65 AE，并接受了包括双重过滤血浆置换（DFPP）、类固醇和免疫抑制剂在内的治疗。然而，患者出现血栓形成并被诊断为II型肝素诱导的血小板减少症（HIT），从而引发了并发症。他接受了口服抗凝剂治疗并最终康复。一个月后，随访检查显示没有栓子存在，且他的癫痫仍得到良好控制。在PE治疗期间存在HIT的风险，这是一种对肝素的潜在危险不良反应。当前病例突出了在PE期间监测HIT的重要性以及使用替代抗凝剂的必要性。
