LAUSR

Case patient A is a 9-years-old Caucasian girl who presented with altered mental status. Three weeks prior to presentation, the patient's mother reported a gradual onset of dizziness, intermittent vomiting, and behavioral changes. She developed urinary incontinence and audiovisual hallucinations 1 week prior to hospitalization. A lumbar puncture performed on admission was positive for anti-N-methyl-D-aspartate (NMDA) receptor antibody (titer 80) with negative cerebrospinal fluid chemistry, cell count, gram stain, and culture. She received Rituximab, intravenous (IV) methylprednisolone with an oral steroid taper, and IVIgG with progression of neurologic symptoms. Plasma exchange therapy was initiated per the 2019 American Society for Apheresis (ASFA) Guidelines for (NMDA) Receptor Antibody Encephalitis.