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Ophelia syndrome: Hodgkin lymphoma with limbic encephalitis
Monica Juneja1, Satnam Kaur, Devendra Mishra
1Department of Pediatrics, Maulana Azad Medical College and associated Lok Nayak hospital; and *Department of Pediatric Hemato-Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini; New Delhi, India. Correspondence to: Dr Satnam Kaur, Assistant Professor, Department of Pediatrics, Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi 110 002, India. sk_doc@yahoo.co.in.
Background:
Limbic encephalitis, an immune-mediated encephalitis, results from inflammation in the medial temporal lobes. The paraneoplastic form is rare in pediatric population, and frequently precedes tumor diagnosis.
Case Characteristics:
A 9-year-old boy receiving chemotherapy for Hodgkin lymphoma, developed headache, temporal lobe seizures, anxiety, hallucinations, short-term memory loss and autonomic disturbances. Magnetic resonance imaging of brain showed features suggestive of limbic encephalitis. Electro-encephalography showed diffuse slowing with no epileptiform discharges.
Outcome:
We diagnosed paraneoplastic form of limbic encephalitis. Treatment with steroids and intravenous immunoglobulin failed, and the child died 4 weeks after onset of symptoms.
Message:
Limbic encephalitis should be kept as differential diagnosis in a child with sub-acutely evolving neuropsychiatric symptoms.
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