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Anti-NMDAR-Positive Small-Cell Lung Cancer Paraneoplastic Limbic Encephalitis: A Case Report and Literature Review

INTRODUCTION: Paraneoplastic limbic encephalitis (PLE) is a rare disease that presents as rapid onset dementia characterized by short-term memory loss (STM), anxiety, and behavioral changes. Anti-NMDAR antibodies are unfrequently reported in PLE associated with small-cell lung cancer (SCLC). Given t...

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Autores principales: Sohal, Raman, Adams, Steven H., Phogat, Vishal, Harish, Abha, Lopez, Carlos Ynigo D., Williams, Michael P. A., Khurana, Kamal K., Abuzuaiter, Basel, Jagroop, Nia, Narapureddy, Bhavya
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7288224/
https://www.ncbi.nlm.nih.gov/pubmed/32566334
http://dx.doi.org/10.1155/2020/5269352
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author Sohal, Raman
Adams, Steven H.
Phogat, Vishal
Harish, Abha
Lopez, Carlos Ynigo D.
Williams, Michael P. A.
Khurana, Kamal K.
Abuzuaiter, Basel
Jagroop, Nia
Narapureddy, Bhavya
author_facet Sohal, Raman
Adams, Steven H.
Phogat, Vishal
Harish, Abha
Lopez, Carlos Ynigo D.
Williams, Michael P. A.
Khurana, Kamal K.
Abuzuaiter, Basel
Jagroop, Nia
Narapureddy, Bhavya
author_sort Sohal, Raman
collection PubMed
description INTRODUCTION: Paraneoplastic limbic encephalitis (PLE) is a rare disease that presents as rapid onset dementia characterized by short-term memory loss (STM), anxiety, and behavioral changes. Anti-NMDAR antibodies are unfrequently reported in PLE associated with small-cell lung cancer (SCLC). Given that PLE can precede the diagnosis of cancer, it is very important that once infectious, metabolic, nutritional, or structural disorders associated with short-term memory loss are ruled out that vigorous effort must be made to rule out underlying malignancy. CASE: We report a rare case of PLE as the presenting symptom of SCLC. A 72-year-old male with history of COPD was brought to the ED by his wife after he was found to have short-term memory loss, including forgetfulness of his wedding anniversary the day before, and anxiety. Neurological exam showed impaired short-term recall on MOCA. CT head showed no evidence of infarct. Lumbar puncture was performed which showed lymphocytic pleocytosis, a nonspecific inflammatory change. CSF panel was negative for HSV, Neisseria, Hemophilus, E. coli, and HIV. Initial EEG was unremarkable, though a repeat EEG showed mild slowing of the posterior dominant rhythm consistent with mild encephalopathy. MRI showed equivocal increased FLAIR on T2-weighted images in the bilateral temporal lobes, left greater than right. CTA thorax showed bulky mediastinal and right hilar LAD. FNA of the R4 lymph node revealed SCLC. The NM bone scan showed no osteoblastic lesions. While the serum autoantibody panel was positive for anti-NMDAR, the CSF autoantibody panel returned entirely negative. Chemotherapy with etoposide and cisplatin was started on Day 4 of admission. The patient's neurological symptoms showed improvement following chemotherapy. CONCLUSION: This case highlights the importance of recognizing short-term memory loss as a feature of PLE.
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spelling pubmed-72882242020-06-18 Anti-NMDAR-Positive Small-Cell Lung Cancer Paraneoplastic Limbic Encephalitis: A Case Report and Literature Review Sohal, Raman Adams, Steven H. Phogat, Vishal Harish, Abha Lopez, Carlos Ynigo D. Williams, Michael P. A. Khurana, Kamal K. Abuzuaiter, Basel Jagroop, Nia Narapureddy, Bhavya Case Rep Neurol Med Case Report INTRODUCTION: Paraneoplastic limbic encephalitis (PLE) is a rare disease that presents as rapid onset dementia characterized by short-term memory loss (STM), anxiety, and behavioral changes. Anti-NMDAR antibodies are unfrequently reported in PLE associated with small-cell lung cancer (SCLC). Given that PLE can precede the diagnosis of cancer, it is very important that once infectious, metabolic, nutritional, or structural disorders associated with short-term memory loss are ruled out that vigorous effort must be made to rule out underlying malignancy. CASE: We report a rare case of PLE as the presenting symptom of SCLC. A 72-year-old male with history of COPD was brought to the ED by his wife after he was found to have short-term memory loss, including forgetfulness of his wedding anniversary the day before, and anxiety. Neurological exam showed impaired short-term recall on MOCA. CT head showed no evidence of infarct. Lumbar puncture was performed which showed lymphocytic pleocytosis, a nonspecific inflammatory change. CSF panel was negative for HSV, Neisseria, Hemophilus, E. coli, and HIV. Initial EEG was unremarkable, though a repeat EEG showed mild slowing of the posterior dominant rhythm consistent with mild encephalopathy. MRI showed equivocal increased FLAIR on T2-weighted images in the bilateral temporal lobes, left greater than right. CTA thorax showed bulky mediastinal and right hilar LAD. FNA of the R4 lymph node revealed SCLC. The NM bone scan showed no osteoblastic lesions. While the serum autoantibody panel was positive for anti-NMDAR, the CSF autoantibody panel returned entirely negative. Chemotherapy with etoposide and cisplatin was started on Day 4 of admission. The patient's neurological symptoms showed improvement following chemotherapy. CONCLUSION: This case highlights the importance of recognizing short-term memory loss as a feature of PLE. Hindawi 2020-06-02 /pmc/articles/PMC7288224/ /pubmed/32566334 http://dx.doi.org/10.1155/2020/5269352 Text en Copyright © 2020 Raman Sohal et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Sohal, Raman
Adams, Steven H.
Phogat, Vishal
Harish, Abha
Lopez, Carlos Ynigo D.
Williams, Michael P. A.
Khurana, Kamal K.
Abuzuaiter, Basel
Jagroop, Nia
Narapureddy, Bhavya
Anti-NMDAR-Positive Small-Cell Lung Cancer Paraneoplastic Limbic Encephalitis: A Case Report and Literature Review
title Anti-NMDAR-Positive Small-Cell Lung Cancer Paraneoplastic Limbic Encephalitis: A Case Report and Literature Review
title_full Anti-NMDAR-Positive Small-Cell Lung Cancer Paraneoplastic Limbic Encephalitis: A Case Report and Literature Review
title_fullStr Anti-NMDAR-Positive Small-Cell Lung Cancer Paraneoplastic Limbic Encephalitis: A Case Report and Literature Review
title_full_unstemmed Anti-NMDAR-Positive Small-Cell Lung Cancer Paraneoplastic Limbic Encephalitis: A Case Report and Literature Review
title_short Anti-NMDAR-Positive Small-Cell Lung Cancer Paraneoplastic Limbic Encephalitis: A Case Report and Literature Review
title_sort anti-nmdar-positive small-cell lung cancer paraneoplastic limbic encephalitis: a case report and literature review
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7288224/
https://www.ncbi.nlm.nih.gov/pubmed/32566334
http://dx.doi.org/10.1155/2020/5269352
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