Four kinds of antibody positive paraneoplastic limbic encephalitis: A rare case report

Abstract

Background: It is not uncommon to develop autoimmune encephalitis and paraneoplastic neurological syndromes (PNS). 4 kinds of antibody-positive autoimmune paraneoplastic limbic encephalitis (PLE) have not been reported.

Case summary: PNS are distant effects of cancer on the nervous system, rather than syndromes in which cancer directly invades and metastasizes to the nerves and/or muscle tissues. If the limbic lobe system of the brain is involved, this will result in PLE. The detection of patients with PNS is challenging since tumors that cause paraneoplastic neurologic disorders are often asymptomatic, obscure, and thus easily misdiagnosed or missed. Currently, single- or double-antibody-positive paraneoplastic marginal encephalitis has been reported. However, no cases of three or more-antibody-positive cases have been reported. Here, we report a case of PLE that is anti-collapsing response-mediator protein-5, anti-neuronal nuclear antibody-type 1, anti-aminobutyric acid B receptor, and anti-glutamate deglutase positive, and address relevant literature to improve our understanding of the disease.

Conclusion: This article reports on the management of a case of PLE with four positive antibodies, a review of the literature, in order to raise awareness among clinicians.

Keywords: Case report; Paraneoplastic limbic encephalitis; anti-aminobutyric acid B receptor; anti-collapsing response-mediator protein-5; anti-glutamate deglutase; anti-neuronal nuclear antibody-type 1.

Figure 1

Chest computed tomography. Soft tissue cluster shadows near the lower left of the right lung.

Figure 2

Head magnetic resonance imaging. A and B: T1 and diffusion-weighted imaging: no abnormal signal; C and D Head magnetic resonance imaging T2 fluid attenuated inversion recovery and Strengthen: the left hippocampus was thickened, and there was a slightly higher signal.

Figure 3

Electroencephalogram. The patient showed the background was diffuse low-medium amplitude irregular slow wave, with no obvious asymmetry on both sides, and the baseline was unstable.