[Three patients with a paraneoplastic neurological syndrome: the significance of paraneoplastic antibodies].
Establishing the presence of paraneoplastic antibodies is important in identifying an often severe neurological syndrome as paraneoplastic and hence directing the search for an underlying neoplasm. A paraneoplastic neurological syndrome was diagnosed in 3 patients. The first was a 64-year-old woman in whom paraneoplastic encephalomyelitis was diagnosed. The diagnosis was strongly supported by a high titre of serum anti-Hu antibodies, despite three negative biopsies from a mediastinal mass. The patient died of a non-convulsive status epilepticus; autopsy revealed not only paraneoplastic encephalomyelitis but also small-cell lung cancer. The second patient was a 55-year-old woman with metastatic breast cancer. After a three-year period of progressive neurological deterioration, a high titre of anti-CV2/CRMP5 antibodies was detected, on the basis of which the clinical syndrome was diagnosed as paraneoplastic. She received immunotherapy and her condition stabilised. The third patient, a 41-year-old man, presented with severe limbic encephalitis. Biopsy from a paraaortic mass was positive for undifferentiated carcinoma. The patient had a high titre ofanti-Ma2 antibodies and was subsequently tested positive for serum alpha-foetoprotein (AFP) and beta-human-chorionic gonadotrophin (bta-HCG). During chemotherapy for a non seminoma testicular cancer, the limbic encephalitis improved both clinically and radiologically, but the patient died as a result of the toxicity of the treatment.
Smitt
P A E Sillevis
PA
p.sillevissmitt@erasmusmc.nl
Polman
S K L
SK
de Beukelaar
J W K
JW
Enting
R H
RH
van den Bent
M J
MJ
Bromberg
J E
JE
Kros
J M
JM
Hooijkaas
H
H
D000328:Adult; D000912:Antibodies, Neoplasm / Q000032:analysis* / Q000276:immunology; D001943:Breast Neoplasms / Q000150:complications / Q000276:immunology / Q000473:pathology; D018288:Carcinoma, Small Cell / Q000150:complications / Q000175:diagnosis / Q000276:immunology; D005260:Female; D006801:Humans; D020363:Limbic Encephalitis / Q000150:complications / Q000175:diagnosis / Q000276:immunology; D008175:Lung Neoplasms / Q000150:complications / Q000175:diagnosis / Q000276:immunology; D008297:Male; D008875:Middle Aged; D010257:Paraneoplastic Syndromes / Q000175:diagnosis* / Q000209:etiology / Q000276:immunology*; D013226:Status Epilepticus / Q000175:diagnosis / Q000209:etiology / Q000276:immunology; D013736:Testicular Neoplasms / Q000150:complications / Q000175:diagnosis / Q000276:immunology
D000912:Antibodies, Neoplasm