case_images: PMC11264605_01
case_images: PMC11264605_02
case_images: PMC11264605_03
case_images: PMC11264605_04
case_images: PMC11264605_05
case_images: PMC11264605_06
case_images: PMC11264605_07
case_images: PMC11264605_08
case_images: PMC11264605_09
case_images: PMC11264605_10
case_images: PMC11264605_11
case_images: Graphical summarization of the treatment. The scale of doses for methylprednisolone (grey) and rituximab is shown on the left side of the graph. The scale of doses for prednisone (yellow), IVIg (orange), and ScIg (dark red) is shown on the right side of the graph. Plasma exchange (light blue) is shown for illustrative purposes as to when it was performed.
case_images: fnhum-18-1405617-g001.jpg
case_images: PMC11264605_11_fnhum-18-1405617-g001.jpg
case_images: fig1
case_images: Graphical summarization of the used evaluation scales. The sum scores for the scales ONLS (grey) and INCAT (yellow) are shown on the left side of the graph. The sum scores for the scales I-RODS (light blue) and MRC (orange) are shown on the right side of the graph. For the MRC scale, the more sensitive muscle groups were picked to be evaluated and comprise the shown sum: upper arm abductors, elbow flexors, wrist extensors, hip flexors, knee extensors, and foot dorsal flexors. The figure represents changes in evaluation scores throughout the clinical case. By comparing with Figure 1, primary improvement was observed following corticosteroid therapy, and the following declines can be attributed to prednisone dose reduction, from 30 mg/day and lower. There seemed to be an improvement after rituximab treatment in the first 24 days (between days 79 and 103), but following that, there was a decline in the patient's state as the prednisone dose was reduced. The improvement after starting rituximab should typically be seen after 2 months of treatment, yet there was no clear improvement. Substantial improvement became apparent after starting treatment with subcutaneous immunoglobulin, which is apparent in the evaluation scores and reduction in the prednisone dose following day 205.
case_images: fnhum-18-1405617-g002.jpg
case_images: PMC11264605_11_fnhum-18-1405617-g002.jpg
case_images: fig2