Encephalitis with antibodies to GluN2B during administration of clozapine

Junji Gon, Yasushi Takehisa, Yuji Yada, Yoshiki Kishi, Etsuko Oshima, Yukitoshi Takahashi, Manabu Takaki

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Clozapine's immunomodulatory properties may contribute to its effect on schizophrenia as well as various adverse effects. However, a possible relationship between N-methyl-D-aspartate-type glutamate receptor antibodies, refractory schizophrenia, and clozapine has not been reported. We experienced a patient who developed refractory schizophrenia that mimicked an exacerbation of encephalitis with antibodies to Nmethyl-D-aspartate-type glutamate receptor (GluN2B) after administration of clozapine for 26 days.We performed plasma exchange 5 times and subsequent steroid pulse therapy. The level of consciousness improved within a few weeks, but involuntary movement as well as psychotic symptoms remained. The production of anti-GluN2B antibodies may have contributed to the patient's resistance to the antipsychotic effects of clozapine in addition to mediating the encephalitis. When we administer clozapine to patients with refractory schizophrenia, we should be careful to differentiate between a diagnosis of refractory schizophrenia and encephalitis with antibodies to GluN2B.

Original languageEnglish
Pages (from-to)320-321
Number of pages2
JournalClinical Neuropharmacology
Issue number6
Publication statusPublished - Nov 28 2016


  • Clozapine
  • Encephalitis with NMDA-type glutamate receptor antibodies
  • Immunoregulatory system
  • Immunotherapy
  • Refractory schizophrenia

ASJC Scopus subject areas

  • Pharmacology
  • Clinical Neurology
  • Pharmacology (medical)


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