Refractory anti-NMDAR encephalitis with multiple nosocominal infections: Paradigm shift required in the therapeutical options

Background: With no randomised controlled trials or consensus guidelines for the treatment of anti-NMDAR encephalitis, the heterogeneity in the treatment stratagem has not yet reported any evidence on the therapeutic option of choice when infections ensue during the immunosuppression therapy. Here, we report a case that highlights the answer to this existing gap of treating refractory anti-NMDAR Encephalitis during multiple nosocomial infections.
Clinical Details: An 18y/o female patient diagnosed with anti-NMDAR Encephalitis is found to be refractory to 1^st and 2^nd line treatment. During her hospital stay, the patient encounters nearly 6 episodes of infections which is worsening her prognosis and delaying the use of next-line intervention. However, the clinician plans to treat the patient with the first line agent, corticosteroid until the patient recovers from the recurring infection episodes.
Conclusion: The case demonstrates the need for de-escalation of immunosuppression therapy during nosocomial infections and using the patient-tolerated first line agent during the period of infections.