Neuroendocrine tumour metastatic brain disease during immunosuppressive treatment for paraneoplastic GABAB 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: Brain metastasis; GABA-B-receptor antibody; Immunosuppression; Paraneoplastic neurological syndrome; Pulmonary neuroendocrine tumour metastatic disease
• 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-GABABR) 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-GABABR. 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. [Display omitted] •Case report of a 74-year-old patient with progressive cognitive degradation, disorientation, and generalized tonic-clonic seizures.•MRI showed a T2-hyperintense region on bilateral hippocampus, and laboratory results showed a positive titter for GABA-B-receptor antibodies in CFS. Malignancy workup was negative.•Treatment with corticosteroids, immunoglobulin and Cyclophosphamide, after which the patient gets worse, revealing in brain MRI the presence of multiple brain metastases. Immunochemistry, were conclusive for pulmonary neuroendocrine tumor (PNT) metastatic disease.•Did immunosuppression allow tumors growth?