Ophelia syndrome: Hodgkin lymphoma with limbic encephalitis.
BACKGROUND
Limbic encephalitis, an immune-mediated encephalitis, results from inflammation in the medial temporal lobes. The paraneoplastic form is rare in pediatric population, and frequently precedes tumor diagnosis.


METHODS
A 9-year-old boy receiving chemotherapy for Hodgkin lymphoma, developed headache, temporal lobe seizures, anxiety, hallucinations, short-term memory loss and autonomic disturbances. Magnetic resonance imaging of brain showed features suggestive of limbic encephalitis. Electro-encephalography showed diffuse slowing with no epileptiform discharges.


RESULTS
We diagnosed paraneoplastic form of limbic encephalitis. Treatment with steroids and intravenous immunoglobulin failed, and the child died 4 weeks after onset of symptoms.


CONCLUSIONS
Limbic encephalitis should be kept as differential diagnosis in a child with sub-acutely evolving neuropsychiatric symptoms.
Department of Pediatrics, Maulana Azad Medical College and associated Lok Nayak hospital; and *Department of Pediatric Hemato-Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini; New Delhi, India. Correspondence to: Dr Satnam Kaur, Assistant Professor, Department of Pediatrics, Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi 110 002, India. sk_doc@yahoo.co.in.
Monica
M
Juneja
Satnam
S
Kaur
Devendra
D
Mishra
Silky
S
Jain
D001921:Brain / Q000473:pathology; D002648:Child; D017809:Fatal Outcome; D006689:Hodgkin Disease; D006801:Humans; D020363:Limbic Encephalitis; D008279:Magnetic Resonance Imaging; D008297:Male; D010257:Paraneoplastic Syndromes