Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis was first reported in 2005 in four patients with ovarian teratomas; there have been many further cases reported since the antigen for the NMDAR antibody was confirmed in 2007. Patients characteristically have a well-defined set of features, characterised by psychiatric disturbance, seizures and cognitive disturbance, followed by movement disorders, disorders of consciousness and dysautonomia. To date, 14 cases of NMDAR encephalitis have been described in the context of pregnancy. We report a case of NMDAR encephalitis in a 34-year-old woman at 8 weeks’ gestation. She had a turbulent clinical course and was initially admitted to a psychiatric unit. She was successfully treated with first-line immunomodulatory therapies and surgical resection of an ovarian teratoma. Following discharge she delivered a healthy baby and made a complete clinical recovery.
Autoimmune haemolytic anaemia (AIHA) and paroxysmal nocturnal haemoglobinuria (PNH) are two distinct causes of haemolytic anaemia. They have different mechanisms that underpin their pathogenesis and, therefore, require different treatment strategies. The direct antiglobulin test (DAT) or Coombs test is positive in cases of immune-mediated haemolytic anaemia and, thus, is positive in AIHA but negative in PNH. We report a case of a woman presenting with a haemolytic anaemia who was found to have concomitant evidence of AIHA and PNH. The case highlights the importance of carrying out a comprehensive haemolysis work-up in patients who present with haemolytic anaemia.
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Highly active multiple sclerosis (HAMS) is a clinical phenotype defined by recent disease activity and determines the indication for disease modifying treatments (DMTs). However, prognosis of HAMS is unknown in terms of progression rates.HAMS subjects were recruited to research cohort in 2010. Audits were performed in 2015 and 2019. Progression was assessed according to EDSS criteria by treating clinicians.128/200 subjects had data at all timepoints. Mean age at baseline was 39.5yrs, disease duration 6.6yrs and entry EDSS was 3.3; 80.4% female. Mean relapse number in the year prior to recruitment was 1.9 and 30.5% had gadolinium enhancing lesions. 33% had not received DMTs at baseline and by 33 months 5% were still off DMTs.At 33 months follow-up 17.2% had progressed and 33% by 81 months. However, of those progressing at 33 months 23% of this group had not progressed further or improved by 81 months. There was no difference in progression rates at 81 months in those on DMTs (29/86) at baseline and continued and those who were not (13/42).In HAMS 32.8% had progressed by 6.75 years. Using EDSS progression as an outcome in this cohort, earlier treatment with the DMTs did not appear to affect prognosis.
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