# A Multidisciplinary Approach to a Treatment-Resistant Anti-N-Methyl-D-Aspartate Receptor Encephalitis Patient in the ICU: A Case Report

## TL;DR

This case report describes a rare autoimmune brain disorder and the patient's response to a new treatment approach.

## Contribution

The novelty lies in the use of rituximab and a multidisciplinary approach for a treatment-resistant anti-NMDAR encephalitis case.

## Key findings

- The patient showed clinical improvement after rituximab treatment following failed IVIG/PLEX.
- The case highlights the importance of early tumor detection and individualized immunotherapy.
- A multidisciplinary approach was crucial for managing this complex autoimmune disorder.

## Abstract

Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an autoimmune disorder characterized by complex neuropsychiatric features and the presence of immunoglobulin G (IgG) antibodies against the receptor subunit 1 (NR1) of the NMDA receptors in the central nervous system. In this case report, we present a 31-year-old female patient who was admitted to the hospital with altered mental status, hallucinations, and seizure activity. After the failure of first-line treatment with intravenous immunoglobulin/plasma exchange (IVIG/PLEX) started at the previous facility, the patient was started on a trial of rituximab, which showed clinical improvement. This case report aims to shed light on the progression of a rare disorder, early tumor detection, individualized immunotherapy, and a multidisciplinary approach to treatment plans.