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Case Report We explain an incident of anti-NMDA receptor encephalitis in an 18-year-old African American female presenting with modern, clinically refractory disease. Despite two rounds of high-dose intravenous steroids, plasma trade, immunoglobulin administration, and rituximab for B-cell depletion, the individual did not react by hospital time 42 and obtained off-label use for the proteasome inhibitor bortezomib. During the 15 times after the bortezomib management, the individual showed dramatic neurol