Rapid clinical stabilization following eculizumab therapy in severe anti-NMDAR encephalitis.
Yang Liu, Yujing Yuan, Yingjie Zhang et al.
✦ AI-curated · Sources linked
Case in brief
A young patient with severe anti-NMDAR encephalitis developed seizures, psychiatric and behavioral symptoms, dyskinesia, and dysautonomia. The patient remained severely disabled despite intravenous methylprednisolone and intravenous immunoglobulin. Peripheral blood testing showed elevated C5a and soluble C5b-9, suggesting activation of the terminal complement pathway. Following eculizumab, which targets complement component C5, seizures ceased and psychiatric symptoms improved rapidly. The report describes clinical stabilization after complement inhibition in a patient whose illness had not improved adequately with first-line immunotherapy.
What made this case unusual
Elevated terminal complement markers accompanied severe disease that remained disabling after first-line immunotherapy; rapid improvement in seizures and psychiatric symptoms followed eculizumab.
Diagnostic / clinical pearl
In severe anti-NMDAR encephalitis with inadequate response to first-line immunotherapy, elevated C5a and soluble C5b-9 may indicate terminal complement activation; this case reports rapid improvement after C5 inhibition.
Why it matters
The case supports further consideration of complement inhibition as a potential strategy for selected patients, while not establishing its efficacy beyond this individual report.