Novy Jan, Carota Antonio, Eggimann Philippe, Pusztaszeri Marc, Rossetti Andrea O, Du Pasquier Renaud
CHUV, Neurology Department, Rue du Bugnon, Lausanne, 1011, Switzerland.
BMJ Case Rep. 2009;2009. doi: 10.1136/bcr.12.2008.1363. Epub 2009 Aug 11.
We report on a 70-year-old woman with partial complex status epilepticus who was initially diagnosed with herpes simplex-2 (HSV-2) encephalitis, based on brain magnetic resonance imaging (MRI) findings, cerebrospinal fluid (CSF) lymphocytic pleocytosis and HSV-2 DNA detection by polymerase chain reaction (PCR) in the CSF, but without improvement on intravenous acyclovir. Anti-Ri antibodies were positive and computed tomography (CT) investigations revealed a small cell carcinoma at biopsy suggesting paraneoplastic encephalitis. The outcome was unfavourable and the autopsy showed typical features of paraneoplastic encephalitis but no evidence of viral inclusions. This case report is interesting because: (1) it is the first report of an autopsy proven paraneoplastic widespread encephalitis with anti-Ri antibodies; (2) despite a positive HSV-2 PCR in the CSF, there was no sign of herpetic infections of the nervous system; and (3) it illustrates the fact that if paraneoplastic antibodies are usually good markers of the underlying tumour, they are not always predictive of neurological deficits.
我们报告了一名70岁患有部分性癫痫持续状态的女性患者，最初根据脑磁共振成像（MRI）结果、脑脊液（CSF）淋巴细胞增多以及脑脊液中通过聚合酶链反应（PCR）检测到单纯疱疹病毒2型（HSV-2）DNA，诊断为HSV-2脑炎，但静脉注射阿昔洛韦后病情无改善。抗Ri抗体呈阳性，计算机断层扫描（CT）检查显示活检发现小细胞癌，提示副肿瘤性脑炎。结局不佳，尸检显示有副肿瘤性脑炎的典型特征，但未发现病毒包涵体证据。该病例报告之所以有趣，原因如下：（1）这是首例经尸检证实的伴有抗Ri抗体的副肿瘤性播散性脑炎报告；（2）尽管脑脊液中HSV-2 PCR呈阳性，但无神经系统疱疹感染迹象；（3）它说明了这样一个事实，即尽管副肿瘤抗体通常是潜在肿瘤的良好标志物，但它们并不总是能预测神经功能缺损。
