Paraneoplastic coma and acquired central alveolar hypoventilation as a manifestation of brainstem encephalitis in a patient with ANNA-1 antibody and small-cell lung cancer.
BACKGROUND
Paraneoplastic neurological disorders are a well recognized complication of malignancy.


METHODS
A case report to expand the currently described clinical manifestations of type 1 antineuronal antibody (ANNA-1)-associated paraneoplastic encephalomyelitis to include coma.


RESULTS
We present an unusual case of fluctuating coma and rapid fulminant progression to acute respiratory failure from central alveolar hypoventilation caused by ANNA-1 paraneoplastic encephalomyelitis associated with small-cell lung carcinoma. Paraneoplastic infiltration of the brainstem and cerebellum, including respiratory and arousal centers, was documented on autopsy.


CONCLUSIONS
Paraneoplastic encephalomyelitis should be considered as a possible cause of coma and central alveolar hypoventilation.
Lee
Kwan S
KS
Department of Critical Care, Mayo Clinic, Scottsdale, AZ 85054, USA.
Higgins
Michaela J
MJ
Patel
Bhavesh M
BM
Larson
Joel S
JS
Rady
Mohamed Y
MY
D000368:Aged; D000912:Antibodies, Neoplasm / Q000276:immunology; D001323:Autoantibodies / Q000276:immunology; D001933:Brain Stem / Q000473:pathology*; D018288:Carcinoma, Small Cell / Q000150:complications / Q000276:immunology / Q000473:pathology; D003128:Coma / Q000150:complications*; D003937:Diagnosis, Differential; D051959:ELAV Proteins / Q000276:immunology*; D004679:Encephalomyelitis / Q000150:complications* / Q000473:pathology*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000276:immunology / Q000473:pathology; D008279:Magnetic Resonance Imaging; D009419:Nerve Tissue Proteins / Q000276:immunology; D009474:Neurons / Q000276:immunology; D010257:Paraneoplastic Syndromes / Q000150:complications / Q000276:immunology / Q000473:pathology; D020182:Sleep Apnea, Central / Q000150:complications* / Q000175:diagnosis*
D000912:Antibodies, Neoplasm; D001323:Autoantibodies; D051959:ELAV Proteins; D009419:Nerve Tissue Proteins