Abrupt Termination of Severe Treatment Refractory Neuropsychiatric Symptoms in a Patient Treated With Rituximab-A Case Report
IMPACT:
This case report discusses an adult experiencing ongoing, severe neuropsychiatric symptoms that was eventually diagnosed as a possible systemic lupus erythematosus-related process. SLE can present with psychiatric symptoms before the onset of physical features. Following treatment with rituximab at a multi-disciplinary clinic, the patient experienced substantial improvement, highlighting the importance of investigating possible autoimmune contributors when psychiatric treatments do not produce the expected outcomes.
SUMMARY
This case report describes an adult woman who experienced severe, progressive neuropsychiatric and cognitive symptoms that did not respond to psychiatric treatments over the course of two years. Her symptoms included paranoia, social withdrawal, impaired thinking, and a substantial loss of independence in daily activities. Despite extensive evaluation, the underlying cause remained unclear. Subtle laboratory findings and a history of pernicious anemia raised the possibility of an autoimmune process.
Following multidisciplinary evaluation, clinicians treated the patient with rituximab. She experienced substantial improvement in her neuropsychiatric symptoms and cognitive functioning. Within six months, she had nearly returned to her baseline level of functioning.
The authors highlight the potential role of autoimmune disease in treatment-resistant neuropsychiatric presentations, even when diagnostic testing does not establish a clear autoimmune diagnosis. Abrupt symptom onset, cognitive decline, motor abnormalities, a personal or family history of autoimmunity, and poor response to standard psychiatric treatments may warrant further evaluation with a multidisciplinary care team.
LINK TO PAPER: https://doi.org/10.1155/crps/6717967
CITATION
Albert, Daniel, Rosen, Brian, Madan, Juliette, Abrupt Termination of Severe Treatment Refractory Neuropsychiatric Symptoms in a Patient Treated With Rituximab—A Case Report, Case Reports in Psychiatry, 2026, 6717967, 5 pages, 2026. https://doi.org/10.1155/crps/6717967