{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T04:59:11Z","timestamp":1781240351311,"version":"3.54.1"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100012542","name":"Sichuan Provincial Science and Technology Support Program","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012542","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006321","name":"National Institutes of Natural Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100006321","id-type":"DOI","asserted-by":"publisher"}]}],"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>Febrile infection-related epilepsy syndrome (FIRES) is a severe epileptic encephalopathy with limited treatment options. Neuroinflammation, particularly involving IL-1\u03b2 and IL-6, is a key driver. Evidence on sequential use of IL-6 receptor blockade (tocilizumab) followed by IL-1 receptor blockade (anakinra) is scarce, especially when IL-1\u03b2 levels are normal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A previously healthy 6-year-old boy developed super-refractory status epilepticus six days after influenza A infection. He failed multiple antiseizure medications, anesthetics, corticosteroids, intravenous immunoglobulin, ketogenic diet, and mild therapeutic hypothermia. Cerebrospinal fluid (CSF) and serum cytokine testing showed elevated IL-6 but normal IL-1\u03b2. After initial improvement with tocilizumab, seizures relapsed. Tocilizumab retreatment and plasma exchange were ineffective. Switching to daily subcutaneous anakinra led to rapid seizure control within five days. He was weaned off anesthetics, extubated, and eventually discharged with mild cognitive dysfunction (PCPC score 2). At one-month follow-up, he had rare brief seizures and attended school.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case demonstrates that anakinra can be effective in tocilizumab-refractory FIRES even when CSF and serum IL-1\u03b2 levels are normal. Anakinra should be considered as a second-line option in selected patients, regardless of IL-1\u03b2 biomarker status.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1866775","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T04:45:59Z","timestamp":1781239559000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Anakinra for tocilizumab-refractory febrile infection-related epilepsy syndrome with normal IL-1\u03b2 levels: a case report"],"prefix":"10.3389","volume":"17","author":[{"given":"Lijun","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Ministry of Education Key Laboratory of Women and Children\u2019s Diseases and Birth Defects, West China Second University Hospital, Sichuan University","place":["Chengdu, Sichuan, China"]},{"name":"Department of Pediatrics, West China Second University Hospital (WCSUH)-Tianfu\u00b7Sichuan Provincial Children\u2019s Hospital","place":["Meishan, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deyuan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Ministry of Education Key Laboratory of Women and Children\u2019s Diseases and Birth Defects, West China Second University Hospital, Sichuan University","place":["Chengdu, Sichuan, China"]},{"name":"Department of Pediatrics, West China Second University Hospital (WCSUH)-Tianfu\u00b7Sichuan Provincial Children\u2019s Hospital","place":["Meishan, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianjun","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Ministry of Education Key Laboratory of Women and Children\u2019s Diseases and Birth Defects, West China Second University Hospital, Sichuan University","place":["Chengdu, Sichuan, China"]},{"name":"Department of Pediatrics, West China Second University Hospital (WCSUH)-Tianfu\u00b7Sichuan Provincial Children\u2019s Hospital","place":["Meishan, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Ministry of Education Key Laboratory of Women and Children\u2019s Diseases and Birth Defects, West China Second University Hospital, Sichuan University","place":["Chengdu, Sichuan, China"]},{"name":"Department of Pediatrics, West China Second University Hospital (WCSUH)-Tianfu\u00b7Sichuan Provincial Children\u2019s Hospital","place":["Meishan, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanling","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Ministry of Education Key Laboratory of Women and Children\u2019s Diseases and Birth Defects, West China Second University Hospital, Sichuan 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