SHM Converge Scientific Abstract ePoster Gallery-Small Cell Lung Cancer Presenting as Paraneoplastic Encephalomyelitis

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This case describes an 80-year-old woman with a history of breast cancer and liver injury who presented with nine months of progressive weakness and weight loss, followed by 2–3 months of confusion, memory loss, and focal status epilepticus. Initial evaluation showed mild hyponatremia and elevated liver enzymes. Despite treatment with multiple anti-seizure medications, her epileptic events did not improve.<br /><br />Hospital workup included continuous EEG, which showed left temporal epileptiform discharges, and brain MRI findings consistent with autoimmune limbic encephalitis. Lumbar puncture revealed elevated CSF protein with normal glucose, and autoimmune/paraneoplastic testing identified a type 1 antineuronal nuclear antibody (anti-Hu) titer of 1:28. Infectious studies were negative. Because of concern for a paraneoplastic process, a full-body PET scan was performed and showed pulmonary nodules. Biopsy later confirmed small cell lung cancer (SCLC).<br /><br />She was treated for status epilepticus with Ativan, Onfi, and phenytoin. For the paraneoplastic encephalomyelitis/autoimmune encephalitis, she received a 5-day course of high-dose IV Solumedrol and IVIG. At discharge, she remained on Keppra and Onfi with rescue medications for breakthrough seizures, and she was scheduled for oncology, neurology, and hepatology follow-up.<br /><br />The case highlights that altered mental status, seizures, and weight loss should prompt consideration of a paraneoplastic syndrome, even before a malignancy is known. Neurologic symptoms may appear early in SCLC, and diagnosis depends on careful clinical assessment, antibody testing, neuroimaging, and malignancy evaluation.

Asset Subtitle

Andrew L. DeGroot

Meta Tag

Author List Andrew L. DeGroot, Astha Subhash, Devesh Kumar, Nisar Asmi

Category Clinical Vignettes

Concept Paraneoplastic Syndrome

Concept Paraneoplastic Encephalomyelitis

Concept Paraneoplastic Neurologic Disease

Concept Anti-Hu Antibody

Concept Small Cell Lung Carcinoma

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Andrew L. DeGroot

Track Adult

Keywords

paraneoplastic syndrome

autoimmune encephalitis

anti-Hu antibody

small cell lung cancer

limbic encephalitis

status epilepticus

altered mental status

weight loss

EEG abnormalities

IVIG and steroids

Paraneoplastic Syndrome

Paraneoplastic Encephalomyelitis

Paraneoplastic Neurologic Disease

Anti-Hu Antibody

Small Cell Lung Carcinoma