Anti-N-Methyl-D-Aspartate Encephalitis as Paraneoplastic Manifestation of Germ-Cells Tumours: A Cases Report and Literature Review

Figure 3

Treatment grouped by patient. P1, P3, P4, and P5 received methylprednisolone (1 g IV daily) during 5 days; P2 and P6 received methylprednisolone according their weight (1mg/kg) also during 5 days. IVIG was administered in five cases at immunomodulatory doses (400-800mg/kg/day). P2 and P3 needed cyclophosphamide (750 mg/m² IV) every three weeks during 4 cycles; P4 received cyclophosphamide (750 mg/m² IV) 2 cycles with 6 weeks between each one. Rituximab was administered every two weeks (375 mg/m² IV) for 2 cycles in P1, P2, P3, and P4. In P2 it was necessary to add four cycles of chemotherapy for immature teratoma repeated every 21 days with bleomycin (30 IU IV every week), etoposide (100mg/m2 IV daily for 5 days), and cisplatin (20mg/m2 IV daily for 5 days).