Lee Seolah, Ahn Seon-Jae, Lee Han Sang, Chu Kon
Department of Neurology, Seoul National University Hospital, Seoul, Korea.
Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Encephalitis. 2023 Jan;3(1):34-38. doi: 10.47936/encephalitis.2022.00122. Epub 2023 Jan 6.
When a patient with encephalopathy has an organic brain lesion, his symptom is easily and often mistakenly attributed to that brain lesion. However, a combination of different conditions is also possible. We present a case of autoimmune limbic encephalitis combined with leptomeningeal carcinomatosis. A 57-year-old female patient was transferred to our institute with a 1-month history of seizure and aggressive behavior. Subacute onset of psychosis with multifocal T2 high signal lesions suggested autoimmune encephalitis, and high-dose steroid pulse and immunoglobulin therapy were started. However, a cerebrospinal fluid study revealed metastatic adenocarcinoma of non-small cell lung cancer, of which she was in complete remission state. Osimertinib, a third-generation epidermal growth factor receptor tyrosine kinase inhibitor, was started targeting leptomeningeal metastases while maintaining immunotherapy of rituximab and tocilizumab. Her neurological symptoms showed improvement in response to immunotherapy which lasted approximately 1 month and then deteriorated again. We concluded that her symptoms were more attributable to autoimmune encephalitis than leptomeningeal carcinomatosis, and discontinued osimertinib.
当患有脑病的患者存在器质性脑病变时，其症状很容易且常常被错误地归因于该脑病变。然而，不同情况的组合也是可能的。我们报告一例自身免疫性边缘叶脑炎合并柔脑膜癌病的病例。一名57岁女性患者因有1个月的癫痫发作和攻击性行为病史被转至我院。亚急性起病的精神病伴有多灶性T2高信号病变提示自身免疫性脑炎，遂开始大剂量类固醇冲击及免疫球蛋白治疗。然而，脑脊液检查显示为非小细胞肺癌转移性腺癌，而她当时处于完全缓解状态。在维持利妥昔单抗和托珠单抗免疫治疗的同时，开始使用第三代表皮生长因子受体酪氨酸激酶抑制剂奥希替尼靶向治疗柔脑膜转移。她的神经症状在免疫治疗后有所改善，持续约1个月，之后再次恶化。我们得出结论，她的症状更多归因于自身免疫性脑炎而非柔脑膜癌病，于是停用了奥希替尼。
