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Título

PARANEOPLASTIC ENCEPHALOMIELITIS DUE TO ANTI-HU ANTIBODIES: A CASE REPORT

RESUMO

Case Report: A 75-year-old man, with multiple cardiovascular risk factors and a previous history of heavy smoking, presented to our clinic due to a forty-five days history of progressive right hemiparesis and hemiparesthesia. On neurologic examination he had normal cranial nerve evaluation. Motor examination revealed a right hemiparesis with upper motor signs (DTR were pathological and cutaneous response was extensor). Pinprick was reduced distally and vibration was severely impaired with positive Romberg sign. Brain MRI showed previous lacunar infarcts and no abnormalities in diffusion-weighted imaging. The patient had no signs of infection whatsoever. The CSF analysis showed normal cell count with sligtly increased protein. Nerve conduction studies were normal and needle examination revealed chronic neurogenic features. EEG revealed diffuse desorganized background with no epileptic discharges. After three weeks of hospitalization, the patient’s level of consciousness got progressively worse and orotracheal intubation was needed. In the setting of sensory ataxia, progressive encephalopathy, without focal injury on neuroimaging or signs of infection in an elderly patient, a paraneoplastic panel was ordered, revealing anti-Hu antibodies in CSF and sera. The patient underwent neoplastic screening and a pulmonary nodule was identified. Unfortunately, before it was possible to biopsy the pulmonar mass, he died from infectious complications.

Discussion: Anti-Hu antibodies is part of the onconeurals antibodies. The anti-Hu paraneoplastic neurologic syndrome may present as sensory neuronopathy, chronic gastrointestinal pseudoobstruction, encephalomyelitis, and limbic encephalitis. When anti-Hu is identifiable in blood tests, cancer is almost always found. being small cell lung cancer the most common. Our patient presented risk factors for oncologic disease to his age, previous smoking history, and clinical course. Paraneoplastic syndromes are a differential diagnosis in these cases and investigation of this cause is required.

Final Considerations: Paraneoplastic neurologic syndromes can affect any part of the nervous system. This group of rare disorder is becoming more prevalent as the population age and with new paraneoplastic panel being affordable. The neurologist must include these group of disorder in the differential diagnosis, specially when the patient has risk factors for neoplasm.

Palavras Chave

PARANEOPLASTIC ENCEPHALOMIELITIS; ANTI-HU ANTIBODIES

Área

Neuroimunologia