Small-cell lung cancer with voltage-gated calcium channel antibody-positive paraneoplastic limbic encephalitis: a case report.
BACKGROUND
Paraneoplastic limbic encephalitis is a rare neurological syndrome and clinically characterized by cognitive dysfunction, memory impairment, seizures and psychiatric symptoms. Paraneoplastic limbic encephalitis is most frequently found in small-cell lung cancer, among various malignancies, and antineuronal antibodies are related to the autoimmune mechanism. We experienced a rare case of a patient with small-cell lung cancer with anti-voltage-gated calcium channel antibody-positive paraneoplastic limbic encephalitis.


METHODS
A 61-year-old Japanese man with a history of smoking cigarettes presented with seizure, confusion and personality change in acute onset. Brain magnetic resonance imaging showed high signal intensity on T2-weighted image in his right temporal lobe, suggestive of limbic encephalitis. A mediastinoscopy of the lymph node revealed small-cell lung carcinoma, and he was staged as having limited stage disease. Antibodies against P/Q-type and N-type voltage-gated calcium channel were positive and Hu antibody was negative. He was started on chemotherapy of carboplatin plus etoposide with concurrent thoracic radiotherapy. Neurological symptoms were gradually improved after systemic chemotherapy.


CONCLUSIONS
We should be alert to the potential of malignant neoplasms associated with paraneoplastic limbic encephalitis when we examine a patient with cancer with neurological disorders such as personality change, disorientation, unconsciousness and memory loss. A clinical marker such as voltage-gated calcium channel antibody may help our diagnosis in clinical practice.
Department of Medicine and Molecular Science, Graduate School of Medicine, Gunma University, Showa-machi, Maebashi, Gunma 371-8511, Japan. kkaira1970@yahoo.co.jp.
Kyoichi
K
Kaira
Takashi
T
Okamura
Hiroki
H
Takahashi
Norio
N
Horiguchi
Noriaki
N
Sunaga
Takeshi
T
Hisada
Masanobu
M
Yamada
D001323:Autoantibodies / Q000276:immunology*; D001921:Brain / Q000473:pathology; D020864:Calcium Channels, N-Type / Q000276:immunology*; D006801:Humans; D020363:Limbic Encephalitis / Q000209:etiology* / Q000276:immunology; D008175:Lung Neoplasms / Q000150:complications* / Q000276:immunology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D049268:Positron-Emission Tomography; D055752:Small Cell Lung Carcinoma / Q000150:complications* / Q000276:immunology
D001323:Autoantibodies; D020864:Calcium Channels, N-Type