case_images: PMC10295819_01
case_images: MRIs of a patient with leptomeningeal metastases with possible autoimmune encephalitis. (A, B) The initial brain MRI shows subtle T2 high-signal lesions but no definite leptomeningeal enhancement. (C) MRI performed immediately after administration of intravenous immunoglobulin shows increased cortical signals in the right temporal cortex and newly appearing multifocal white matter hyperintensities. (D) Newly appearing leptomeningeal enhancement. (E, F) MRI was performed after multiple doses of rituximab and tocilizumab.. MRI, magnetic resonance image.
case_images: encephalitis-2022-00122f1.jpg
case_images: PMC10295819_01_encephalitis-2022-00122f1.jpg
case_images: f1-encephalitis-2022-00122
case_images: The initial brain magnetic resonance imaging (MRI) showed bilateral cortical swelling without definite cortical or leptomeningeal enhancement (Figure 1A and B). Due to the patient's aggravating clinical symptoms and progressive swelling evident on brain MRI (Figure 1B and C), she was immediately treated with intravenous immunoglobulin (IVIg) followed by rituximab (RTX; 375 mg/m2) and tocilizumab (TCZ; 4 mg/kg) (CASE score, 16 and mRS score, 5; 47 hospital days).
case_images: Treatment schedule and progress of clinical assessment scales. The schedule and effect of immunotherapy (steroid, intravenous immunoglobulin [IVIg], rituximab [RTX], and tocilizumab [TCZ]) are represented by clinical assessment scales: the Glasgow Coma Scale (GCS), modified Rankin Scale (mRS), and Clinical Assessment Scale in Autoimmune Encephalitis (CASE). Initial IVIg treatment was effective at reducing psychosis, suggesting an autoimmune pathology. Each dose of RTX and TCZ resulted in an increase in the GCS and a reduction in mRS and CASE scores.. ARDS, acute respiratory distress syndrome; SNUH, Seoul National University Hospital.
case_images: encephalitis-2022-00122f2.jpg
case_images: PMC10295819_01_encephalitis-2022-00122f2.jpg
case_images: f2-encephalitis-2022-00122
case_images: The patient has been prescribed 80 mg daily of osimertinib, a third-generation EGFR tyrosine kinase inhibitor (TKI), while maintaining weekly RTX and monthly TCZ treatments (Figure 2).