Fig. 1.

Serologic response to the treatment. Shown are serum (triangles; left y-axis) and CSF (dots; right y-axis) titers of NMDAR antibodies, and RNA HIV 1 viral load (diamonds) measured over 30 weeks (x-axis). Week 4 corresponds to the diagnosis of anti-NMDAR encephalitis. The patient was given 5-day pulses of intravenous methylprednisolone (1 g per day) and intravenous immunoglobulin (0.2 g/kg per day; vertical rectangle), and 5 sessions of PE (inverted triangles) on alternate days. Despite a decrease in the serum anti-NMDAR titer at week 7, there was no clinical improvement, after which PE was performed daily over the next 7 days. Clinical improvement at week 10 corresponds to a decrease in the CSF anti-NMDAR titer. Rituximab (spheres) was given once a week for 4 weeks (375 mg/m² per week), and cyclophosphamide (squares) was given once a month for 3 months (15 mg/kg/pulse). Mycophenolate mofetil (horizontal rectangle) 250 mg b.i.d. was increased by 500 mg on a weekly basis up to a maintenance dosage of 1,000 mg b.i.d. CSF, cerebrospinal fluid; NMDAR, anti-N-methyl-D-aspartate receptor; IVIg, intravenous immunoglobulin; PE, plasma exchange.