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Case Reports in Neurological Medicine
Volume 2013, Article ID 608643, 4 pages
http://dx.doi.org/10.1155/2013/608643
Case Report

Paraneoplastic Limbic Encephalitis Resembling Acute Herpetic Encephalitis

1Department of Neurology, “St. Panteleimon” General State Hospital of Piraeus, 18454 Nikaia, Greece
2Department of Neurology, Essex Centre for Neurological Sciences, Queen’s Hospital, Romford, Essex RM7 0AG, UK

Received 7 October 2013; Accepted 27 October 2013

Academic Editors: P. Berlit and J.-H. Park

Copyright © 2013 Ioannis Markakis et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction. Paraneoplastic limbic encephalitis (PLE) is a rare disorder that typically follows a chronic or subacute course of personality changes, memory loss, seizures, and hallucinations. Early diagnosis is difficult and characteristic symptoms can be mimicked by a variety of conditions. We present a case of PLE, initially presenting as acute herpetic encephalitis. Case Presentation. A 56-year-old male was admitted for evaluation of acute onset headache, fever, and confusion. On neurological examination he was confused with MMSE score of 15/30. CSF analysis revealed marked lymphocytic pleocytosis. A possible diagnosis of acute herpetic encephalitis was rendered and patient was treated with acyclovir. CSF PCR was negative. Cranial MRI revealed bilateral hyperintense lesions in medial temporal lobes with contrast enhancement. Despite treatment with acyclovir patient was deteriorated; thus, a paraneoplastic syndrome was suspected. Chest CT showed a right paratracheal lymph node mass, while a biopsy revealed neuroendocrine lung cancer. Auto antibodies to Hu were also detected. The patient was treated with steroids and chemotherapy. Six months later, he had complete tumour remission and marked neurological improvement. Discussion. PLE can rarely invade acutely, being indistinguishable from herpetic encephalitis. Inclusion of PLE in the differential diagnosis of acute encephalitis is of great clinical significance.