Neuroendocrine tumour metastatic brain disease during immunosuppressive treatment for paraneoplastic GABA B receptor antibodies encephalitis: Is immunosuppression always beneficial?

• Published in: Journal of neuroimmunology 2017-09, Vol.310, p.66-68
• Main Authors: André, Ana, Félix, Ana, Shamasna, Motasem, Nzwalo, Hipólito, Basílio, Carlos
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - pathology; Adenocarcinoma - surgery; Aged; Autoantibodies - blood; Brain - diagnostic imaging; Brain - pathology; Brain Neoplasms - pathology; Brain Neoplasms - surgery; Cognition Disorders - etiology; Epilepsy, Tonic-Clonic - diagnostic imaging; Epilepsy, Tonic-Clonic - etiology; Humans; Immunosuppressive Agents - therapeutic use; Limbic Encephalitis - diagnostic imaging; Limbic Encephalitis - etiology; Limbic Encephalitis - pathology; Limbic System - diagnostic imaging; Lung Neoplasms - pathology; Magnetic Resonance Imaging; Male; Receptors, GABA-B - immunology
• ISSN: 0165-5728; 1872-8421
• DOI: 10.1016/j.jneuroim.2017.06.009

Limbic autoimmune encephalitis (LE) should be considered in any patient with acute or subacute neuropsychiatric manifestations, without other common causes of encephalitis. Y-Aminobutyric-acid-B-receptor (anti-GABA R) antibodies are rarely encountered in association with LE. A 74-year-old patient presented with a progressive cognitive degradation and generalized tonic-clonic seizures, with positive anti-GABA R. He declined under immunosuppression treatment. Control magnetic resonance revealed brain lesions, which became positive for pulmonary neuroendocrine tumour metastatic disease. The occurrence of diversified neurological manifestations of an underling tumour is difficult to manage. We speculate if in some cases, immunosuppression can itself facilitate tumour progression.