Paraneoplastic Limbic Encephalitis Resembling Acute Herpetic Encephalitis

Introduction. Paraneoplastic limbic encephalitis (PLE) is a rare disorder that typically follows a chronic or subacute course of personality changes, memory loss, seizures, and hallucinations. Early diagnosis is difficult and characteristic symptoms can be mimicked by a variety of conditions. We pr...

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Main Authors:	Markakis, Ioannis, Papathanasiou, Athanasios, Papageorgiou, Ermioni, Siarkos, Kostantinos, Gkekas, Georgios
Format:	Online
Language:	English
Published:	Hindawi Publishing Corporation 2013
Online Access:	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860150/

id	pubmed-3860150
recordtype	oai_dc
spelling	pubmed-38601502013-12-29 Paraneoplastic Limbic Encephalitis Resembling Acute Herpetic Encephalitis Markakis, Ioannis Papathanasiou, Athanasios Papageorgiou, Ermioni Siarkos, Kostantinos Gkekas, Georgios Case Report Introduction. Paraneoplastic limbic encephalitis (PLE) is a rare disorder that typically follows a chronic or subacute course of personality changes, memory loss, seizures, and hallucinations. Early diagnosis is difficult and characteristic symptoms can be mimicked by a variety of conditions. We present a case of PLE, initially presenting as acute herpetic encephalitis. Case Presentation. A 56-year-old male was admitted for evaluation of acute onset headache, fever, and confusion. On neurological examination he was confused with MMSE score of 15/30. CSF analysis revealed marked lymphocytic pleocytosis. A possible diagnosis of acute herpetic encephalitis was rendered and patient was treated with acyclovir. CSF PCR was negative. Cranial MRI revealed bilateral hyperintense lesions in medial temporal lobes with contrast enhancement. Despite treatment with acyclovir patient was deteriorated; thus, a paraneoplastic syndrome was suspected. Chest CT showed a right paratracheal lymph node mass, while a biopsy revealed neuroendocrine lung cancer. Auto antibodies to Hu were also detected. The patient was treated with steroids and chemotherapy. Six months later, he had complete tumour remission and marked neurological improvement. Discussion. PLE can rarely invade acutely, being indistinguishable from herpetic encephalitis. Inclusion of PLE in the differential diagnosis of acute encephalitis is of great clinical significance. Hindawi Publishing Corporation 2013 2013-11-27 /pmc/articles/PMC3860150/ /pubmed/24377054 http://dx.doi.org/10.1155/2013/608643 Text en Copyright © 2013 Ioannis Markakis et al. https://creativecommons.org/licenses/by/3.0/ 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.
repository_type	Open Access Journal
institution_category	Foreign Institution
institution	US National Center for Biotechnology Information
building	NCBI PubMed
collection	Online Access
language	English
format	Online
author	Markakis, Ioannis Papathanasiou, Athanasios Papageorgiou, Ermioni Siarkos, Kostantinos Gkekas, Georgios
spellingShingle	Markakis, Ioannis Papathanasiou, Athanasios Papageorgiou, Ermioni Siarkos, Kostantinos Gkekas, Georgios Paraneoplastic Limbic Encephalitis Resembling Acute Herpetic Encephalitis
author_facet	Markakis, Ioannis Papathanasiou, Athanasios Papageorgiou, Ermioni Siarkos, Kostantinos Gkekas, Georgios
author_sort	Markakis, Ioannis
title	Paraneoplastic Limbic Encephalitis Resembling Acute Herpetic Encephalitis
title_short	Paraneoplastic Limbic Encephalitis Resembling Acute Herpetic Encephalitis
title_full	Paraneoplastic Limbic Encephalitis Resembling Acute Herpetic Encephalitis
title_fullStr	Paraneoplastic Limbic Encephalitis Resembling Acute Herpetic Encephalitis
title_full_unstemmed	Paraneoplastic Limbic Encephalitis Resembling Acute Herpetic Encephalitis
title_sort	paraneoplastic limbic encephalitis resembling acute herpetic encephalitis
description	Introduction. Paraneoplastic limbic encephalitis (PLE) is a rare disorder that typically follows a chronic or subacute course of personality changes, memory loss, seizures, and hallucinations. Early diagnosis is difficult and characteristic symptoms can be mimicked by a variety of conditions. We present a case of PLE, initially presenting as acute herpetic encephalitis. Case Presentation. A 56-year-old male was admitted for evaluation of acute onset headache, fever, and confusion. On neurological examination he was confused with MMSE score of 15/30. CSF analysis revealed marked lymphocytic pleocytosis. A possible diagnosis of acute herpetic encephalitis was rendered and patient was treated with acyclovir. CSF PCR was negative. Cranial MRI revealed bilateral hyperintense lesions in medial temporal lobes with contrast enhancement. Despite treatment with acyclovir patient was deteriorated; thus, a paraneoplastic syndrome was suspected. Chest CT showed a right paratracheal lymph node mass, while a biopsy revealed neuroendocrine lung cancer. Auto antibodies to Hu were also detected. The patient was treated with steroids and chemotherapy. Six months later, he had complete tumour remission and marked neurological improvement. Discussion. PLE can rarely invade acutely, being indistinguishable from herpetic encephalitis. Inclusion of PLE in the differential diagnosis of acute encephalitis is of great clinical significance.
publisher	Hindawi Publishing Corporation
publishDate	2013
url	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860150/
_version_	1612037685802696704

Paraneoplastic Limbic Encephalitis Resembling Acute Herpetic Encephalitis

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