RESUMO
Anti-N-methyl-D-aspartate receptor antibody has been associated with a severe stereotypic form of subacute encephalitis, often found in women with ovarian teratoma. Reported here is the diagnosis of anti-N-methyl-D-aspartate receptor encephalitis in a 5-year-old girl who presented with subacute encephalopathy and movement disorder without evidence of malignancy. Early diagnosis and treatment with immune globulin and steroids resulted in near-complete recovery.
Assuntos
Anti-Inflamatórios/uso terapêutico , Anticorpos Anti-Idiotípicos/imunologia , Anticorpos Anti-Idiotípicos/metabolismo , Doenças Autoimunes do Sistema Nervoso , Encefalite , Metilprednisolona/uso terapêutico , Receptores de N-Metil-D-Aspartato/imunologia , Receptores de N-Metil-D-Aspartato/metabolismo , Doenças Autoimunes do Sistema Nervoso/tratamento farmacológico , Doenças Autoimunes do Sistema Nervoso/imunologia , Doenças Autoimunes do Sistema Nervoso/metabolismo , Pré-Escolar , Encefalite/tratamento farmacológico , Encefalite/imunologia , Encefalite/metabolismo , Feminino , HumanosRESUMO
A 37-year-old woman developed a left third cranial nerve palsy 28 years after radiation for a nonsecreting pituitary adenoma. Imaging disclosed a left parasellar mass and a midbrain/pontine signal abnormality. Biopsy of the parasellar mass revealed a malignant sarcoma. The brainstem abnormality was presumptively diagnosed as a malignant glioma. A 63-year-old man developed a malignant astrocytoma of the left optic nerve and chiasm 23 years after partial excision and radiation of a nonsecreting pituitary adenoma. Both patients died of their malignancies. Although secondary malignancies have been described in this setting, such long latencies have not been reported.
Assuntos
Adenoma/radioterapia , Neoplasias do Tronco Encefálico/etiologia , Glioma/etiologia , Neoplasias Induzidas por Radiação/etiologia , Segunda Neoplasia Primária/etiologia , Neoplasias do Nervo Óptico/etiologia , Neoplasias Hipofisárias/radioterapia , Adulto , Neoplasias do Tronco Encefálico/patologia , Neoplasias do Tronco Encefálico/terapia , Evolução Fatal , Feminino , Glioma/patologia , Glioma/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Induzidas por Radiação/patologia , Neoplasias Induzidas por Radiação/terapia , Segunda Neoplasia Primária/patologia , Segunda Neoplasia Primária/terapia , Neoplasias do Nervo Óptico/patologia , Neoplasias do Nervo Óptico/terapia , Fatores de TempoRESUMO
Anti-Ma2-associated encephalitis is a paraneoplastic disorder that predominantly affects the limbic system, diencephalon and brainstem, and is usually associated with tumors of the testis. We report a 35-year-old man with a right testicular mass who presented with multiple neurological complains, and clinical, serological and radiological features compatible with anti-Ma2-associated encephalitis. After three courses of carboplatin, etoposide and bleomycin for metastatic testicular germ-cell tumor, all elevated tumor markers normalized and the retroperitoneal metastases disappeared, but the neurological disorder deteriorated. To our knowledge, this is the first case in which orchiectomy followed by carboplatin, etoposide and bleomycin for a testicular tumor with anti-Ma2 encephalitis was performed.