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case_images: Clinical and laboratory parameters of the NF155+ AN patient treated with telitacicept. (A) The contrast-enhanced MRI images of the brachial and sacral plexuses nerve of the NF155+ AN patient. No thickening features of the nerve roots were observed. (B) The serum anti-NF155 antibodies and anti-NF186 antibodies were detected using the cell-based assay (CBA) in October 2021. The anti-NF155 was seropositive in the titer of 1:1000 (red), while the anti-NF186 was seronegative. EGFP is shown in green fluorescence. (C) The patient was diagnosed with NF155+ AN at the Department of Neurology, Xiangya Hospital, in July 2021. The right axis shows the level of anti-NF155 antibody titers in orange color. The first left axis shows the INCAT scores in blue color. The second left axis shows the peripheral plasmablast cell counts in green color. The rectangles in different colors, including purple, yellow, pink, and red, indicate different treatments the patient received during the period. (D) The serum anti-NF155 was seropositive in the titer of 1:10 (red) after telitacicept treatment in April 2023. PE, plasma exchange; IA, immunoadsorption; NF155, neurofascin-155; NF186, neurofascin-186; EGFP, Enhanced Green Fluorescent Protein.
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case_images: PMC10642300_01_fimmu-14-1279808-g001.jpg
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case_images: Brachial plexus and sacral nerve magnetic resonance imaging (MRI) showed no thickening features of the nerve roots ( Figure 1A ). The patient was readmitted for two more sessions of PE, followed by rituximab, which brought modest improvement ( Figure 1C ). However, anti-NF155 titers surprisingly surged to 1:1000++ after treatment ( Figure 1B ) and the INCAT score remained 8. Treatment with telitacicept was initiated, consisting of four 160mg subcutaneous injections, all under the close monitoring of plasmablast cell counts ( Figure 1C ). Remarkably, the serum anti-NF155 titers remained stable at a low level of 1:10 during the telitacicept regimen ( Figure 1D ), with the patient's symptoms showing gradual improvement and the INCAT scores declining to 1 (0 for arms and 1 for legs).