Abstract
Background. Previous reports on limbic encephalitis as a paraneoplastic syndrome have indicated that in many cases the neurological symptoms do not improve even if the tumor shrinks. We report a case of limbic encephalitis due to small cell lung cancer in which the patient was rescued and his Performance Status (PS) was significantly improved by the performance of antitumor therapy with artificial respiration. Case. A 60-year-old man was transported to our hospital by ambulance due to convulsions. He had repeated spasms and was unable to communicate or walk. Based on the results of our examination, the patient was diagnosed with small cell lung cancer stage IIIB. Head MRI (FLAIR) showed a high signal intensity in the hippocampus and limbic system, and was diagnosed with paraneoplastic limbic encephalitis (PLE). CBDCA+VP-16 was initiated. On the fourth day of treatment he became convulsive, and artificial respiration was initiated to stop his convulsions. He was extubated on the 12th day after the disappearance of spasm and shrinkage of the tumor. No further attacks occurred. A test for anti-Hu antibodies was negative. Head MRI showed improvement of the high signal intensity of the limbic system. Thus, we continued chemotherapy. Thereafter, his consciousness and communication improved, and he was discharged alone, and subsequently returned to work. Conclusion. Although paraneoplastic neurologic symptoms do not generally improve, it is reported that therapeutic effects may be expected for neurological symptoms in patients who are negative for anti-Hu antibodies. Since small cell lung cancer is a tumor with a high temporary treatment response rate, we considered that an antitumor effect could be expected in a patient with a poor performance status before treatment. In this case, treatment could not be delayed until the result of the anti-Hu antibody test were available, and antitumor treatment was provided with artificial respiration control. As a result, we were able to rescue the patient because his neurological symptoms of paraneoplastic limbic encephalitis improved along with the antitumor effect. We believe that among patients with paraneoplastic limbic encephalitis who are anti-Hu antibody-negative and who have a tumor with a high treatment response rate, even cases with a poor PS may be rescued by antitumor therapy.
