PMC7118211_01
Clinical milestones and treatment course of the illustrative case. Schematic representation of the clinical course and the treatment divided into three vertical categories (dotted line): clinical milestones, first-line immunotherapy, and second-line immunotherapy. The X-axis indicates the day of hospitalization, and the gray area indicates the time of bortezomib administration. Anti-NMDA-R, anti-N-methyl-D-aspartate receptor; CSF, cerebrospinal fluid; ICU, intensive care unit; IVIg, intravenous immunoglobulin; LP, lumbar puncture; PLEX, plasma exchange.
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F1
Initial cerebrospinal fluid (CSF) studies revealed elevated white blood cell count with lymphocytic predominance (WBC 21, lymphocytes 92%, RBC <1, protein 16, cells counted 100, glucose 81), and she was started on 1,000 mg methylprednisolone for 5 days (Figure 1). In total, the patient received first-line therapy consisting of methylprednisolone (1,000 mg IV for 5 days), IVIg (two rounds of 2 g/kg over 5 days each), and PLEX (two rounds for 5 days), followed by rituximab at 375 mg/m2 administered weekly (Figure 1).