We report the case of a female adolescent who presented with behavioural changes. She was admitted to our institution due to worsening psychiatric and neurological symptoms, subsequently diagnosed with anti-N-methyl-D-aspartate receptor encephalitis. Additional workup was facilitated to rule out a possible underlying teratoma, but all tests turned out unremarkable. First-line treatment with methylprednisolone pulse therapy and intravenous immunoglobulin was started, to which she showed marked improvement from baseline. One month after discharge, a decision for readmission was made because of persistent episodes of hallucinations, agitation and dyskinesias. In this case report, we highlight the use of cyclophosphamide over rituximab as second-line treatment in a resource-limited setting, owing to its greater availability and lesser cost. Cyclophosphamide treatment was given resulting in a more sustained clinical improvement with return to baseline function.
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Contributors AFPB was able to see the patient, do physical examination and provide daily medical management during the course of the patient’s hospital stay. BS-G and RASQ provided guidance in the patient management. They also provided insights to the actual paper content, focusing especially on the paper’s contributions.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.