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Nwabuobi et al. Thymoma associated panencephalitis

our patient (behavioral/cognitive changes, seizures, P. Thymoma and paraneoplastic myasthenia gravis. Autoimmunity
multifocal T2/FLAIR lesions) with high titer CSF and 2010;43:413-27.
serum antibodies to GABA R. These patients did 2. Kondo K, Yoshizawa K, Tsuyuguchi M, Kimura S, Sumitomo M,
Morita J, Miyoshi T, Sakiyama S, Mukai K, Monden Y. WHO
A
not have evidence of thymoma, however, did have histologic classification is a prognostic indicator in thymoma. Ann
other evidence of immune dysregulation, including Thorac Surg 2004;77:1183-8.
the presence of other antibodies. Most importantly, 3. Evoli A, Lancaster E. Paraneoplastic disorders in thymoma patients. J
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the GABA R antibody was shown to have pathogenic Thorac Oncol 2014;9:S143-7.
A
effects on the antigen, specifically, downregulation 4. Graus F, Titulaer MJ, Balu R, Benseler S, Bien CG, Cellucci
of receptors in cultured neuronsand patients usually T, Cortese I, Dale RC, Gelfand JM, Geschwind M, Glaser CA,
responded to therapy. [8,9] Furthermore, Ohkawa et al. Honnorat J, Hoftberger R, Iizuka T, Irani SR, Lancaster E, Leypoldt
[9]
retested the sera of 2 patients previously with TAPE F, Pruss H, Rae-Grant A, Reindl M, Rosenfeld MR, Rostasy K, Saiz
A, Venkatesan A, Vincent A, Wandinger KP, Waters P, Dalmau J. A
via a nonbiased proteomic method and identified clinical approach to diagnosis of autoimmune encephalitis. Lancet
antibodies to GABA R. Our patient was not tested Neurol 2016;15:391-404.
A
for this antibody, however, his clinical findings, brain 5. Ohta M, Itoh M, Hara H, Itoh N, Nishitani H, Hayashi K, Ohta K.
imaging, and response to therapy are suggestive of Anti-skeletal muscle and anti-acetylcholine receptor antibodies in
GABA R associated panencephalitis. patients with thymoma without myasthenia gravis: relation to the
A
onset of myasthenia gravis. Clin Chim Acta 1991;201:201-5.
One of the setbacks in managing TAPE is early 6. Lai M, Huijbers MG, Lancaster E, Graus F, Bataller L, Balice-Gordon
recognition as there are so few cases reported. PNS R, Cowell JK, Dalmau J. Investigation of LGI1 as the antigen in
limbic encephalitis previously attributed to potassium channels: a case
associated with antineuronal cell surface antibodies series. Lancet Neurol 2010;9:776-85.
are often highly responsive to treatment, while those 7. Yu Z, Kryzer TJ, Griesmann GE, Kim K, Benarroch EE, Lennon VA.
with onconeuronal antibodies have a generally poor CRMP-5 neuronal antibody: marker of lung cancer and thymoma-
response. Review of the cases shows responses related autoimmunity. Ann Neurol 2001;49:146-54.
[10]
to treatments differed without any clear correlation to 8. Petit-Pedrol M, Armangue T, Peng X, Bataller L, Cellucci T, Davis R,
antibody types. Every patient received thymomectomy McCracken L, Martinez-Hernandez E, Mason WP, Kruer MC, Ritacco
with partial or full response followed by a combination DG, Grisold W, Meaney BF, Alcala C, Sillevis-Smitt P, Titulaer MJ,
of steroids, plasmapheresis and/or IVIG. This Balice-Gordon R, Graus F, Dalmau J. Encephalitis with refractory
seizures, status epilepticus, and antibodies to the GABAA receptor: a
suggests that early surgical removal of tumors with case series, characterisation of the antigen, and analysis of the effects
or without immunotherapy could provide a good of the antibodies. Lancet Neurol 2014;13:276-86.
chance of recovery from disease. Albeit, the presence 9. Okhawa T, Satake S, Yokoi N, Miyazaki Y, Ohshita T, Sobue G,
of both cell-surface and onconeuronal antibodies in Takashima H, Watanabe O, Fukata Y, Fukata M. Identification and
our patient may indicate a poor prognosis despite his characterization of GABAa receptor autoantibodies in autoimmune
initial rapid improvement. encephalitis. J Neurosci 2014;34:8151-63.
10. Hoftberger R, Rosenfeld MR, Dalmau J. Update on neurological
paraneoplastic syndromes. Curr Opin Oncol 2015;27:489-95.
Authors’ contributions 11. Reginold W, Ninan K, Coret-Simon J, Haider E. Paraneoplastic limbic
Concept, literature search, preparation, editing and and extra-limbic encephalitis secondary to a thymoma mimicking an
revision of manuscript: L. Nwabuobi acute stroke. Can J Neurol Sci 2016;43:420-3.
Patient data and imaging acquisition, editing and 12. Simabukuro MM, Petit-Pedrol M, Castro LH, Nitrini R, Lucato L,
revision of manuscript: J. Pellinen Zambon AA, Silva, LG, Fortes GC, Soares Neto HR, Dalmau JO.
Supervision and revision of manuscript: T. Wisniewski GABAa receptor and LGI1 antibody encephalitis in a patient with
thymoma. Neurol Neuroimmunol Neuroinflamm 2015;2:e73.
Financial support and sponsorship 13. Aragaki M, Iimura Y, Teramoto K, Sato N, Hirose K, Hasegawa N.
None. Paraneoplastic extralimbic encephalitis associated with thymoma: a
case report. Ann Thorac Cardiovasc Surg 2015;21:300-402.
14. Aysal F, Baybas S, Selcuk HH, Sozmen V, Ozturk M, Kucukoglu H,
Conflicts of interest Urer NH. Paraneoplastic extralimbic encephalitis associated with
There are no conflicts of interest. thymoma and myasthenia gravis: three years follow up. Clin Neurol
Neurosurg 2013;115:628-31.
Patient consent 15. Suh JW, Haam SJ, Song SW, Shin YR, Paik HC, Lee DY.
Verbal consent was obtained from the patient. Paraneoplastic encephalitis associated with thymoma: a case report.
Korean J Thorac Cardiovasc Surg 2013;46:234-6.
Ethics approval 16. Miyazaki Y, Hirayama M, Watanabe H, Usami N, Yokoi K, Watanabe
Not applicable. O, Sobue G. Paraneoplastic encephalitis associated with myasthenia
gravis and malignant thymoma. J Clin Neurosci 2012;19:336-8.
17. Erkmen CP, Fadul CE, Dalmau J, Erkmen K. Thymoma-associated
REFERENCES paraneoplastic encephalitis (TAPE): diagnosis and treatment of a
potentially fatal condition. J Thorac Cardiovasc Surg 2011;141:17-20.
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122 Neuroimmunology and Neuroinflammation ¦ Volume 4 ¦ June 16, 2017