A Rare Case of Paraneoplastic Encephalitis in Association With Breast Cancer

Kavita Agrawal, Nirav Agrawal

Abstract


We present a case of a 47-year-old female who presented with diffuse dysesthetic pain in both legs for past 3 months. She described the sensation as of pins and needles. She also had balance difficulty and developed progressively worsening back pain and spasms. Relatives reported that the patient had memory difficulties. The patient would repeat questions even after the questions had already been answered. Magnetic resonance imaging (MRI) of cervical, thoracic and lumbosacral spine with and without contrast showed mild multilevel degenerative changes in cervical spine and minimal disc bulges from L1 to S1 levels with no areas of significant spinal canal or neural foraminal stenosis. MRI of brain was performed which showed abnormal T2/FLAIR hyperintensity along the left medial temporal lobe and additional small foci in the right centrum semiovale/corona radiate and bilateral periventricular white matter. Based on the MRI findings, a diagnosis of limbic encephalitis was made. A lumbar puncture was also done. Cerebrospinal fluid (CSF) showed 14 oligoclonal bands with elevated IgG synthesis. Paraneoplastic antibody panel showed high titers of amphiphysin antibody (1:15,360). Since this is a paraneoplastic antibody, computed tomography of chest, abdomen and pelvis was performed. It showed several enlarged right axillary lymph nodes. Ultrasound of right breast showed 4 mm hypoechoic nodule at 2 o’clock axis (upper inner quadrant). The biopsy of this lesion and axillary lymph node showed invasive ductal carcinoma of the breast. For further evaluation, MRI of bilateral breast was performed. It revealed additional areas of enhancements in upper outer and lower outer quadrants of right breast. Biopsy of the upper outer area of enhancement revealed invasive ductal carcinoma and ductal carcinoma in situ (DCIS). Biopsy of the lower outer aspect showed infiltrating lobular carcinoma and lobular carcinoma in situ (LCIS). Our report highlights a rare patient presenting with paraneoplastic limbic encephalitis with underlying breast cancer. When encountering a patient with unexplained neurologic symptoms, paraneoplastic neurological syndromes (PNSs) should be considered as part of the differential. And a thorough search of autoantibodies associated with PNS should be considered. If such autoantibodies are present, search for an underlying malignancy should be undertaken.




J Med Cases. 2018;9(9):296-302
doi: https://doi.org/10.14740/jmc3120w

Keywords


Encephalitis; Diffuse dysesthetic pain; Magnetic resonance imaging; Cerebrospinal fluid; Paraneoplastic neurological syndrome

Full Text: HTML PDF
 
Home     |     Log In     |      About     |      Search     |      Current     |      Archives     |      Submit      |     Subscribe


 

     

Aims and Scope

Current Issues

Conflict of Interest

About Publisher

Editorial Board

Archives

Copyright

Company Profile

Editorial Office

Misconduct and Retraction

Permissions

Company Registration

Contact Us

Abstracting and Indexing

ICMJE

Ownership

Instructions to Authors

Access

Declaration of Helsinki

Contact Publisher

Submission Checklist

Reprints

Terms of Use

Company Address

Submit a Manuscript

Open Access Policy

Privacy Policy

Browse Journals

Publishing Fee

Publishing Policy

Disclaimer

Recent Highlights

Peer-Review Process

Publishing Quality

Code of Ethics

Advertising Policy

Manuscript Tracking

Advanced Search

For Librarians

Careers

Publishing Process

Publication Frequency

For Reviewers

Propose a New Journal

       
       

Journal of Medical Cases, monthly, ISSN 1923-4155 (print), 1923-4163 (online), published by Elmer Press Inc.        
The content of this site is intended for health care professionals.
This is an open-access journal distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted
non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Creative Commons Attribution license (Attribution-NonCommercial 4.0 International CC-BY-NC 4.0)


This journal follows the International Committee of Medical Journal Editors (ICMJE) recommendations for manuscripts submitted to biomedical journals,
the Committee on Publication Ethics (COPE) guidelines, and the Principles of Transparency and Best Practice in Scholarly Publishing.

website: www.journalmc.org   editorial contact: editor@journalmc.org
Address: 9225 Leslie Street, Suite 201, Richmond Hill, Ontario, L4B 3H6, Canada

© Elmer Press Inc. All Rights Reserved.

DECLARATION: THIS JOURNAL SITE OUTLOOK IS DESIGNED BY THE PUBLISHER AND COPYRIGHT PROTECTED. DO NOT COPY!