{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T11:19:07Z","timestamp":1788261547810,"version":"build-2803163510"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Anti-\n                      <jats:italic>N<\/jats:italic>\n                      -methyl-D-aspartate receptor (anti-NMDAR) encephalitis often requires intensive care and rapid escalation of immunotherapy. We report a critically ill woman with refractory anti-NMDAR encephalitis treated with tocilizumab (TCZ) as early second-line therapy and discuss the rationale for IL-6 receptor blockade over other treatment strategies.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case report<\/jats:title>\n                    <jats:p>A previously healthy 30-year-old woman developed psychosis, catatonia, dyskinesias, and refractory status epilepticus; anti-NMDAR antibodies were detected in the CSF using a commercial fixed cell-based assay. She required mechanical ventilation and received methylprednisolone and IVIG 35 days after symptom onset, without improvement. The course was complicated by sepsis, dialysis-dependent acute kidney injury, anemia, and thrombocytopenia. Given active infection, cytopenias, and prior hepatitis B exposure, TCZ was initiated with tenofovir prophylaxis. Over the subsequent 30 days, she improved, was extubated, and became seizure-free. Rituximab (RTX) was started 9 months after onset. At 25-month follow-up, outcomes were mRS 2, CASE 1, and MoCA 26\/30.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case describes rapid clinical improvement temporally associated with TCZ administration in a critically ill patient with refractory anti-NMDAR encephalitis. Although causality cannot be established, TCZ may offer a rapid and time-limited immunomodulatory option for carefully selected ICU patients when conventional second-line therapies are unsuitable. Prospective controlled studies are required to determine its efficacy and optimal timing.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1809134","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T10:56:55Z","timestamp":1788260215000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Tocilizumab for critically ill patients with refractory anti-NMDAR encephalitis: a case report"],"prefix":"10.3389","volume":"17","author":[{"given":"Renato Pierre","family":"Lima","sequence":"first","affiliation":[{"name":"Instituto de Ensino e Pesquisa, Hospital Israelita Albert Einstein","place":["S\u00e3o Paulo, SP, Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. H. 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