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Pharmaceutical care of rituximab in the treatment of children with refractory anti-NMDAR encephalitis: A case report

Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is a rare disease of nervous system, which is mediated by autoimmune mechanisms. The treatment of anti-NMDAR encephalitis includes Immunotherapy, symptomatic and supportive treatment for seizures and psychiatric symptoms. There are many kinds o...

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Autores principales: Wu, Haiyan, Xu, Xiaoyan, Ding, Qixuan, Zhu, Shuangfei, Zheng, Qiaozhen, Ding, Shanshan, Li, Jiyao, Zhao, Hongyang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9901968/
https://www.ncbi.nlm.nih.gov/pubmed/36749271
http://dx.doi.org/10.1097/MD.0000000000032843
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author Wu, Haiyan
Xu, Xiaoyan
Ding, Qixuan
Zhu, Shuangfei
Zheng, Qiaozhen
Ding, Shanshan
Li, Jiyao
Zhao, Hongyang
author_facet Wu, Haiyan
Xu, Xiaoyan
Ding, Qixuan
Zhu, Shuangfei
Zheng, Qiaozhen
Ding, Shanshan
Li, Jiyao
Zhao, Hongyang
author_sort Wu, Haiyan
collection PubMed
description Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is a rare disease of nervous system, which is mediated by autoimmune mechanisms. The treatment of anti-NMDAR encephalitis includes Immunotherapy, symptomatic and supportive treatment for seizures and psychiatric symptoms. There are many kinds of drugs, so drug treatment management and pharmaceutical care for children are particularly important. At present, there are few reports on pharmaceutical care for children with this disease. Clinical pharmacists participated in the pharmaceutical care of a child with refractory anti-NMDAR encephalitis treated with rituximab, conducted drug treatment management on the dosage, administration method, complications and other aspects of off-label use of rituximab, combined with the children’s clinical manifestations, inflammatory indicators, pathogenic detection, blood concentration, liver and kidney functions, drug interactions and other factors. The treatment plan of anti-infective drugs shall be adjusted, and attention shall be paid to whether there are adverse reactions during the treatment. PATIENT CONCERNS: A 4-year-old girl presented with epileptic seizure, intermittent recurrent fever, high inflammatory markers, abnormal psychiatric function/cognitive impairment, language disorder, consciousness disturbance, and movement disorder/involuntary movement. DIAGNOSIS: Refractory anti-NMDAR encephalitis. INTERVENTIONS: The patient was given first-line (3 rounds of methylprednisolone pulse therapy and gamma globulin) and second-line (rituximab) immunotherapy. On the advice of a clinical pharmacist, the patient wasn’t given Advanced antibacterial agents (voriconazole, vancomycin) therapy. On the 41st day of admission, the patient’s temperature and inflammatory indicators were normal, CD19(+) B cells were reduced to 0. OUTCOMES: The patient consciousness level, cognition and orientation were gradually improved, mental disorder was improved, involuntary movement was obviously controlled, no seizure occurred again, and the patient was discharged with stable condition. LESSONS: Clinical pharmacists ensure the safety, effectiveness and economy of patients’ medication by carrying out the whole process of individualized drug treatment management and care for patients.
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spelling pubmed-99019682023-02-08 Pharmaceutical care of rituximab in the treatment of children with refractory anti-NMDAR encephalitis: A case report Wu, Haiyan Xu, Xiaoyan Ding, Qixuan Zhu, Shuangfei Zheng, Qiaozhen Ding, Shanshan Li, Jiyao Zhao, Hongyang Medicine (Baltimore) 4200 Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is a rare disease of nervous system, which is mediated by autoimmune mechanisms. The treatment of anti-NMDAR encephalitis includes Immunotherapy, symptomatic and supportive treatment for seizures and psychiatric symptoms. There are many kinds of drugs, so drug treatment management and pharmaceutical care for children are particularly important. At present, there are few reports on pharmaceutical care for children with this disease. Clinical pharmacists participated in the pharmaceutical care of a child with refractory anti-NMDAR encephalitis treated with rituximab, conducted drug treatment management on the dosage, administration method, complications and other aspects of off-label use of rituximab, combined with the children’s clinical manifestations, inflammatory indicators, pathogenic detection, blood concentration, liver and kidney functions, drug interactions and other factors. The treatment plan of anti-infective drugs shall be adjusted, and attention shall be paid to whether there are adverse reactions during the treatment. PATIENT CONCERNS: A 4-year-old girl presented with epileptic seizure, intermittent recurrent fever, high inflammatory markers, abnormal psychiatric function/cognitive impairment, language disorder, consciousness disturbance, and movement disorder/involuntary movement. DIAGNOSIS: Refractory anti-NMDAR encephalitis. INTERVENTIONS: The patient was given first-line (3 rounds of methylprednisolone pulse therapy and gamma globulin) and second-line (rituximab) immunotherapy. On the advice of a clinical pharmacist, the patient wasn’t given Advanced antibacterial agents (voriconazole, vancomycin) therapy. On the 41st day of admission, the patient’s temperature and inflammatory indicators were normal, CD19(+) B cells were reduced to 0. OUTCOMES: The patient consciousness level, cognition and orientation were gradually improved, mental disorder was improved, involuntary movement was obviously controlled, no seizure occurred again, and the patient was discharged with stable condition. LESSONS: Clinical pharmacists ensure the safety, effectiveness and economy of patients’ medication by carrying out the whole process of individualized drug treatment management and care for patients. Lippincott Williams & Wilkins 2023-02-03 /pmc/articles/PMC9901968/ /pubmed/36749271 http://dx.doi.org/10.1097/MD.0000000000032843 Text en Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY) (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle 4200
Wu, Haiyan
Xu, Xiaoyan
Ding, Qixuan
Zhu, Shuangfei
Zheng, Qiaozhen
Ding, Shanshan
Li, Jiyao
Zhao, Hongyang
Pharmaceutical care of rituximab in the treatment of children with refractory anti-NMDAR encephalitis: A case report
title Pharmaceutical care of rituximab in the treatment of children with refractory anti-NMDAR encephalitis: A case report
title_full Pharmaceutical care of rituximab in the treatment of children with refractory anti-NMDAR encephalitis: A case report
title_fullStr Pharmaceutical care of rituximab in the treatment of children with refractory anti-NMDAR encephalitis: A case report
title_full_unstemmed Pharmaceutical care of rituximab in the treatment of children with refractory anti-NMDAR encephalitis: A case report
title_short Pharmaceutical care of rituximab in the treatment of children with refractory anti-NMDAR encephalitis: A case report
title_sort pharmaceutical care of rituximab in the treatment of children with refractory anti-nmdar encephalitis: a case report
topic 4200
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9901968/
https://www.ncbi.nlm.nih.gov/pubmed/36749271
http://dx.doi.org/10.1097/MD.0000000000032843
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