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

J Neuroimmunol. 2017 Sep 15:310:66-68. doi: 10.1016/j.jneuroim.2017.06.009. Epub 2017 Jun 29.

Abstract

Background: 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.

Case report: 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.

Conclusion: 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.

Keywords: Brain metastasis; GABA-B-receptor antibody; Immunosuppression; Paraneoplastic neurological syndrome; Pulmonary neuroendocrine tumour metastatic disease.

Publication types

  • Case Reports

MeSH terms

  • 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*

Substances

  • Autoantibodies
  • Immunosuppressive Agents
  • Receptors, GABA-B