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Limbic Encephalitis as a Presenting Complication for Small Cell Lung Cancer
Ahmad Abu-Hashyeh1, Abdulrahman Katabi1, Fuad Zeid2
1Internal Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, USA.
Cureus
|September 14, 2020
Summary
Limbic encephalitis (LE), a rare cancer complication, can cause difficult-to-treat seizures. This case highlights small cell lung cancer presenting as refractory status epilepticus, emphasizing the need for prompt LE diagnosis.
Area of Science:
- Neurology
- Oncology
- Immunology
Background:
- Limbic encephalitis (LE) is a rare neurological disorder often linked to paraneoplastic syndromes secondary to malignant tumors.
- LE commonly manifests as refractory seizures, posing diagnostic and therapeutic challenges, especially in patients with pre-existing epilepsy.
Observation:
- A unique case of a 68-year-old patient with a history of epilepsy admitted to the ICU with refractory status epilepticus and respiratory failure.
- Further investigation revealed small cell lung carcinoma and paraneoplastic autoantibodies (Anti-Hu) in the cerebrospinal fluid, confirming autoimmune LE.
- Initial presentation mimicked anti-epileptic treatment failure due to the patient's epilepsy history.
Findings:
- Diagnosis of paraneoplastic autoimmune LE was supported by the presence of Anti-Hu antibodies.
- High-dose steroids showed partial efficacy in reducing seizure frequency.
- The case underscores the importance of considering LE in patients with refractory status epilepticus, even with normal initial brain imaging and CSF analysis.
Implications:
- Early diagnosis of LE is crucial for effective management, requiring exclusion of other causes of status epilepticus.
- Treatment strategies involve addressing the underlying malignancy and employing immunosuppressive therapies, including tacrolimus, cyclophosphamide, IVIG, or plasma exchange.
- This case emphasizes the need for a high index of suspicion for LE in ICU patients with refractory seizures, particularly those with an underlying cancer diagnosis.
