PMC8442530_01
Timeline of the patient treatment. (A-F) Brain MRI (T2-FLAIR) demonstrates autoimmune encephalitis. The patient's level of consciousness (orange arrows, GCS) improved following treatment with high dose steroid (green triangle), intravenous immunoglobulin (yellow circle), and rituximab (red thunderbolt) (G). The CD19+/CD20+ B-cell counts were present during the 5-week to 5-month follow-up after admission. There was the depletion of CD19+/CD20+ B-cell counts within 1 week after an initial infusion of rituximab.
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F1
Brain MRI (T2-FLAIR) revealed abnormal hyperintensity with expansion in the hippocampi, temporal cortex, medial thalami, right insular cortex, left pulvinar, and left parietal lobe, without restricted diffusion (not shown) or contrast enhancement (Figures 1A,B). Brain MRI (T2-FLAIR) also shows T2-FLAIR hyperintensity with atrophy in the left medial temporal lobe (white arrow), right medial temporal lobe (white arrowhead), and left parietal lobe (Figures 1C-F). We suspected antibody-negative AE and started first-line treatment with high-dose intravenous methylprednisolone (1,000 mg) for 5 days, followed by oral prednisolone (Figure 1G). CD19+/CD20+ counts of total lymphocytes in the peripheral blood were 15.3 and 15.1%, respectively (Figure 1G). After receiving rituximab for 3 weeks, the patient's mental status started improving (GCS: E4VtM5), and follow-up brain MRI findings were markedly improved (Figures 1C-F).