Multiple drugs

Abstract

Lack of efficacy: case report A 16-year-old girl exhibited a lack of efficacy during treatment with immune-globulin, unspecified neuroprotector, oxcarbazepine, phenytoin and vitamin-B-complex for seizures. The girl, who had decreased consciousness, repetitive talking, headache, involuntary movements on mouth and feet and seizures, was admitted to the intensive care unit (ICU) in Indonesia in July 2017. Subsequent neurological examination revealed cranial nerves paralysis and seizures. On the first and seventh day after seizures EEG was performed which showed deflection on the left temporal and extent to other brain regions, respectively. Hence, she was initially diagnosed with viral encephalitis, with a differential diagnosis of autoimmune encephalitis. Subsequently, she started receiving anticonvulsants therapies with oxcarbazepine and phenytoin along with unspecified neuroprotector, vitamin-B-complex [vitamin B] and IV immunoglobulin [not all routes stated; dosages not stated]. However, after 4 weeks of therapies, her seizures persisted. Following the physician consultation, encephalitis associated with anti-N-Methyl-D-aspartate (anti-NMDA) receptor was suspected. Due to abnormality in the abdominal cavity, abdominal ultrasound was performed which showed a left adnexal cystic lesion with solid components in size of 3.6x3.2cm. Subsequent rectal ultrasound showed ovarian cysts of 3.2x2.64x3.18cm dimension. Additionally, her serum and cerebrospinal fluid were found to be positive for anti-NMDA receptor antibodies. Based on the clinical investigation, mature ovarian teratoma associated with anti-NMDA receptor encephalitis was diagnosed. Then, she underwent laparotomy left cystectomy surgery. After the surgery, she received first-line medical therapy included unspecified steroid, IV immunoglobulin (IVIG), plasmapheresis and rituximab. Following the therapy, her condition was improved gradually. Thus, she was discharged from the hospital. Around 6 weeks of hospitalisation, her symptoms resolved.