Yang Jianhua, Li Bin, Li Xiaoquan, Lai Zhaohui
Department of Neurology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, China.
Front Oncol. 2020 Mar 27;10:350. doi: 10.3389/fonc.2020.00350. eCollection 2020.
Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a cause of autoimmune encephalitis and is characterized by epileptic seizures, psychosis, and consciousness impairments. It mostly affects young adults with ovarian cancers. We herein reported a case of anti-NMDAR encephalitis associated with clear cell renal carcinoma. A 54-year-old male with headache for 1 week and mood and behavioral changes for 3 days was presented, but his clinical presentation and poor response to antiviral treatment did not support a diagnosis of viral encephalitis. Positive anti-NMDAR antibodies in serum and cerebrospinal fluid confirmed autoimmune encephalitis. A subsequent evaluation revealed a paraneoplastic etiology of a renal mass, and this was then resected and pathologically confirmed as clear cell renal carcinoma. The patient's symptoms showed improvement after resection of the mass. The patient relapsed 6 months after discharge, and the symptoms completely disappeared after treatment with corticosteroids and intravenous immunoglobulin. Our findings suggested that NMDAR encephalitis might be associated with clear cell renal carcinoma. When patients present with unexplained seizures, neuropsychiatric disorder, or other brain symptoms, clinicians should be careful with paraneoplastic neurological disorders. Early diagnosis and treatment of primary tumors might show improvement.
抗N-甲基-D-天冬氨酸受体（NMDAR）脑炎是自身免疫性脑炎的一种病因，其特征为癫痫发作、精神病和意识障碍。它主要影响患有卵巢癌的年轻成年人。我们在此报告一例与透明细胞肾细胞癌相关的抗NMDAR脑炎病例。一名54岁男性，出现头痛1周，情绪和行为改变3天，但其临床表现及对抗病毒治疗的不良反应不支持病毒性脑炎的诊断。血清和脑脊液中抗NMDAR抗体阳性证实为自身免疫性脑炎。随后的评估发现肾脏肿块为副肿瘤病因，随后将其切除并经病理证实为透明细胞肾细胞癌。肿块切除后患者症状有所改善。患者出院6个月后复发，经皮质类固醇和静脉注射免疫球蛋白治疗后症状完全消失。我们的研究结果表明，NMDAR脑炎可能与透明细胞肾细胞癌有关。当患者出现无法解释的癫痫发作、神经精神障碍或其他脑部症状时，临床医生应警惕副肿瘤性神经系统疾病。早期诊断和治疗原发性肿瘤可能会有所改善。
