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Fig. 3 | Journal of Neuroinflammation

Fig. 3

From: Anti-N-methyl-D-aspartate receptor encephalitis: the clinical course in light of the chemokine and cytokine levels in cerebrospinal fluid

Fig. 3

Single case study. A 7-year-old girl represented the most complicated patient in the group, and she remained in a coma for 344 days. a The timeline (in months) of combined immunotherapy and sample withdrawal is shown. She did not respond to the first- or second-line immunotherapy (immunoglobulins = IVIG, plasma exchange = PE, immunoadsorption = IA, rituximab = RTX, cyclophosphamide = CPA). Then, she was experimentally treated with intravenous alemtuzumab combined with two doses of intrathecal methotrexate (MTX) followed by oral mycophenolate mophetil (MMF). Nine successive CSF samples were collected during the 25-month follow-up period. The first two samples anticipated the rapid clinical deterioration (mRS = 1 and 3). The five subsequent samples were collected while she was in a coma (mRS = 5), and the final two samples were collected during the recovery period (mRS = 3 and 2). b The CSF levels of the chemokines CXCL10 and CXCL13 and c of BAFF peaked at disease onset (period 1). The increase in the CXCL13 levels preceded the increase in the CXC10 levels and was followed by rapid clinical deterioration. Subsequently, the concentrations of these factors remained unremarkable despite her coma, as illustrated by the interquartile ranges of the levels in the controls. d In contrast, the CSF levels of Th cell-related cytokines (IFNγ, TNFα and IL17A) were increased throughout the follow-up period. The exception was observed in the sample after the first dose of intrathecal methotrexate and intravenous alemtuzumab, which was shortly before her clinical improvement. Then, the levels of these cytokines increased again without any signs of clinical relapse. The interquartile range of the levels of these cytokines in the controls did not exceed 1.2 pg/mL

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