Adenocarcinoma of the right lung, potential cause of seronegative paraneoplastic encephalitis

Paraneoplastic neurologic disorders are syndromes related to the cancer that can affect any part of the nervous system. Paraneoplastic encephalitis, one of its types, is an inflammatory condition mediated by immune responses triggered by neuronal proteins ectopically expressed by tumours or as a result of altered immunologic responses. Presentation of a malignancy can be varied, and paraneoplastic encephalitis is one of the ways of presentation. A detailed history and examination, clinical suspicion and thorough investigations are a must for its diagnosis. An atypical neurological presentation of the underlying disease was diagnosed with clinical acumen and extensive workup. The patient had a history of altered sensorium and headache (initial suspicion of meningitis) and had normal blood investigations and normal cerebrospinal fluid (CSF) reports. Findings in the MRI of the brain were the clue to the diagnosis. The patient was later worked up for the underlying source of malignancy which turned out to be adenocarcinoma of the right lung. But CSF reports were negative for the paraneoplastic panel. Small cell carcinoma of the lung is commonly known to cause seronegative paraneoplastic encephalitis, but there are no such reports with adenocarcinoma of the lung. Thus, we emphasise for extensive cancer evaluation in all subacutely presenting neurological syndromes with normal CSF reports. We also emphasise that the presence of a positive onconeural antibody is not a must in the diagnosis of paraneoplastic syndrome. We hereby present a case report of a patient with adenocarcinoma of the right lung, presenting as paraneoplastic encephalitis.