Successful sequential therapy with rituximab and telitacicept in refractory Anti-NMDA receptor encephalitis and MOG-associated demyelination: a case report and literature review
Clinical management of the rare and complex overlapping syndrome of MOG-antibody disease and anti-NMDAR encephalitis (MNOS), which has an uncertain pathogenesis and a high risk of recurrence, is highly challenging. We describe the case of a 19 years-old female patient, who first complained of headac...
Saved in:
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2025-02-01
|
| Series: | Frontiers in Immunology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fimmu.2025.1509143/full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832087117699743744 |
|---|---|
| author | Jingliang Zhang Minzhe Hu Chunjuan Wang Shougang Guo |
| author_facet | Jingliang Zhang Minzhe Hu Chunjuan Wang Shougang Guo |
| author_sort | Jingliang Zhang |
| collection | DOAJ |
| description | Clinical management of the rare and complex overlapping syndrome of MOG-antibody disease and anti-NMDAR encephalitis (MNOS), which has an uncertain pathogenesis and a high risk of recurrence, is highly challenging. We describe the case of a 19 years-old female patient, who first complained of headache, fever, and irritability. After that, she experienced frequent seizures and mood disorders. The diagnosis of MNOS was verified through antibody tests and imaging. For the patient, intravenous immunoglobulin and high-dose methylprednisolone were effective as first-line immunotherapy. Long-term immunotherapy with oral prednisone and mycophenolate mofetil was used to prevent relapses. However, over six years, the patient had five relapses when the mycophenolate mofetil dosage was reduced. The patient’s condition stabilized after taking rituximab as second-line immunotherapy, with less than 1% of total lymphocytes being CD19+ cells. Eleven months later, the plasmablast ratio increased, and patients experienced new symptoms such as bilateral optic neuritis. After that, the patient got telitacicept injections regularly for 13 months, during which time her symptoms subsided, and there were no adverse effects or relapses. This case suggests that telitacicept may be a viable adjunct or sequential therapy option for the depletion of B cells in MNOS. |
| format | Article |
| id | doaj-art-4e4be44795fe427ab62f5925938fef79 |
| institution | Kabale University |
| issn | 1664-3224 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Immunology |
| spelling | doaj-art-4e4be44795fe427ab62f5925938fef792025-02-06T07:09:35ZengFrontiers Media S.A.Frontiers in Immunology1664-32242025-02-011610.3389/fimmu.2025.15091431509143Successful sequential therapy with rituximab and telitacicept in refractory Anti-NMDA receptor encephalitis and MOG-associated demyelination: a case report and literature reviewJingliang ZhangMinzhe HuChunjuan WangShougang GuoClinical management of the rare and complex overlapping syndrome of MOG-antibody disease and anti-NMDAR encephalitis (MNOS), which has an uncertain pathogenesis and a high risk of recurrence, is highly challenging. We describe the case of a 19 years-old female patient, who first complained of headache, fever, and irritability. After that, she experienced frequent seizures and mood disorders. The diagnosis of MNOS was verified through antibody tests and imaging. For the patient, intravenous immunoglobulin and high-dose methylprednisolone were effective as first-line immunotherapy. Long-term immunotherapy with oral prednisone and mycophenolate mofetil was used to prevent relapses. However, over six years, the patient had five relapses when the mycophenolate mofetil dosage was reduced. The patient’s condition stabilized after taking rituximab as second-line immunotherapy, with less than 1% of total lymphocytes being CD19+ cells. Eleven months later, the plasmablast ratio increased, and patients experienced new symptoms such as bilateral optic neuritis. After that, the patient got telitacicept injections regularly for 13 months, during which time her symptoms subsided, and there were no adverse effects or relapses. This case suggests that telitacicept may be a viable adjunct or sequential therapy option for the depletion of B cells in MNOS.https://www.frontiersin.org/articles/10.3389/fimmu.2025.1509143/fullNMDAR encephalitis (NMDARE)telitaciceptrituximabtreatmentMOGAD |
| spellingShingle | Jingliang Zhang Minzhe Hu Chunjuan Wang Shougang Guo Successful sequential therapy with rituximab and telitacicept in refractory Anti-NMDA receptor encephalitis and MOG-associated demyelination: a case report and literature review Frontiers in Immunology NMDAR encephalitis (NMDARE) telitacicept rituximab treatment MOGAD |
| title | Successful sequential therapy with rituximab and telitacicept in refractory Anti-NMDA receptor encephalitis and MOG-associated demyelination: a case report and literature review |
| title_full | Successful sequential therapy with rituximab and telitacicept in refractory Anti-NMDA receptor encephalitis and MOG-associated demyelination: a case report and literature review |
| title_fullStr | Successful sequential therapy with rituximab and telitacicept in refractory Anti-NMDA receptor encephalitis and MOG-associated demyelination: a case report and literature review |
| title_full_unstemmed | Successful sequential therapy with rituximab and telitacicept in refractory Anti-NMDA receptor encephalitis and MOG-associated demyelination: a case report and literature review |
| title_short | Successful sequential therapy with rituximab and telitacicept in refractory Anti-NMDA receptor encephalitis and MOG-associated demyelination: a case report and literature review |
| title_sort | successful sequential therapy with rituximab and telitacicept in refractory anti nmda receptor encephalitis and mog associated demyelination a case report and literature review |
| topic | NMDAR encephalitis (NMDARE) telitacicept rituximab treatment MOGAD |
| url | https://www.frontiersin.org/articles/10.3389/fimmu.2025.1509143/full |
| work_keys_str_mv | AT jingliangzhang successfulsequentialtherapywithrituximabandtelitaciceptinrefractoryantinmdareceptorencephalitisandmogassociateddemyelinationacasereportandliteraturereview AT minzhehu successfulsequentialtherapywithrituximabandtelitaciceptinrefractoryantinmdareceptorencephalitisandmogassociateddemyelinationacasereportandliteraturereview AT chunjuanwang successfulsequentialtherapywithrituximabandtelitaciceptinrefractoryantinmdareceptorencephalitisandmogassociateddemyelinationacasereportandliteraturereview AT shougangguo successfulsequentialtherapywithrituximabandtelitaciceptinrefractoryantinmdareceptorencephalitisandmogassociateddemyelinationacasereportandliteraturereview |