Small-cell lung cancer with voltage-gated calcium channel antibody-positive paraneoplastic limbic encephalitis: a case report

Abstract

IntroductionParaneoplastic limbic encephalitis is a rare neurological syndrome and clinically characterized by cognitive dysfunction, memory impairment, seizures and psychiatric symptoms. Paraneoplastic limbic encephalitis is most frequently found in small-cell lung cancer, among various malignancies, and antineuronal antibodies are related to the autoimmune mechanism. We experienced a rare case of a patient with small-cell lung cancer with anti-voltage-gated calcium channel antibody-positive paraneoplastic limbic encephalitis.Case presentationA 61-year-old Japanese man with a history of smoking cigarettes presented with seizure, confusion and personality change in acute onset. Brain magnetic resonance imaging showed high signal intensity on T2-weighted image in his right temporal lobe, suggestive of limbic encephalitis. A mediastinoscopy of the lymph node revealed small-cell lung carcinoma, and he was staged as having limited stage disease. Antibodies against P/Q-type and N-type voltage-gated calcium channel were positive and Hu antibody was negative. He was started on chemotherapy of carboplatin plus etoposide with concurrent thoracic radiotherapy. Neurological symptoms were gradually improved after systemic chemotherapy.ConclusionsWe should be alert to the potential of malignant neoplasms associated with paraneoplastic limbic encephalitis when we examine a patient with cancer with neurological disorders such as personality change, disorientation, unconsciousness and memory loss. A clinical marker such as voltage-gated calcium channel antibody may help our diagnosis in clinical practice.

Paraneoplastic limbic encephalitis associated with lung cancer

“…Concurrent platinum-etoposide and thoracic radiation therapy followed by prophylactic cranial irradiation with curative intent is standard for limited-stage SCLC, and platinum-etoposide remains the first-line therapy for extensive-stage disease 20 , 21 . Most PLE patients with SCLC experience improvement in neurological symptoms after systemic chemotherapy 22 – 24 . We found that neurological improvement was closely related to anti-cancer therapy (chemotherapy or VATS), rather than immunotherapy (Fig.…”

Autoimmune Encephalitis: Pathophysiology and Imaging Review of an Overlooked Diagnosis

“…64,65 ␥-Aminobutyric Acid Receptor ␥-aminobutyric acid encephalitis (GABAr) has 2 subtypes that both have clinical features similar to those of VGKC encephalitis but are less common and have a better overall prognosis. 3,15,43,66 The 2 ␥-aminobutyric acid receptor subtypes have different clinical profiles and are characterized by antibodies to either the ␥-aminobutyric acid A-receptor or B-receptor subunits.…”

The Use of Chemical-Chemical Interaction and Chemical Structure to Identify New Candidate Chemicals Related to Lung Cancer

“…In this study, we identified ten new candidate chemicals related to NSCLC (see the first ten chemicals in Table 2 ). Of these ten candidate chemicals, three chemicals: uracil, magnesium ion, calcium ion (see the first three chemicals in Table 2 ) have been reported to be related to NSCLC in some previous studies [ 52 , 53 , 54 , 55 ]. For the remaining seven candidate chemicals, five were found to have associations with NSCLC according to their currently known functions (listed in rows 4–8 of Table 2 ).…”