Page 405 - Read Online

Almedallah et al. Neuroimmunol Neuroinflammation 2018;5:48 Neuroimmunology and
DOI: 10.20517/2347-8659.2018.55 Neuroinflammation

Case Report Open Access

Paraneoplastic limbic encephalitis associated with
testicular mixed germ cell tumor

Dana Almedallah , Gada Alsaffar , Ghadeer Al-Shabeeb , Aalaa Baarmah , Eman Nassim 2
1,#
1,#
1
2
1 College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia.
2 Department of Neurology, King Fahad Specialist Hospital, Dammam 31444, Saudi Arabia.
# Authors contributed equally.
Correspondence to: Gada Alsaffar, College of Medicine, Imam Abdulrahman Bin Faisal University, 2835 King Faisal Road, Dammam
34212, Saudi Arabia. E-mail: gmsaffar@gmail.com

How to cite this article: Almedallah D, Alsaffar G, Al-Shabeeb G, Baarmah A, Nassim E. Paraneoplastic limbic encephalitis
associated with testicular mixed germ cell tumor. Neuroimmunol Neuroinflammation 2018;5:48.
http://dx.doi.org/10.20517/2347-8659.2018.55

Received: 8 Sep 2018 First Decision: 22 Oct 2018 Revised: 8 Nov 2018 Accepted: 9 Nov 2018 Published: 10 Dec 2018
Science Editor: Athanassios P. Kyritsis Copy Editor: Cui Yu Production Editor: Huan-Liang Wu

Abstract
Paraneoplastic limbic encephalitis (PLE) is a rare immunopathological syndrome, reported in association with
certain types of malignancies. Patients present with cognitive and memory impairments, disordered perception,
mood and behavioral changes, sleep disturbances, and seizures. Despite the growing number of cases being
reported, it still poses a diagnostic challenge. We encountered a patient with a myriad of neuropsychiatric
symptoms who exhibited a highly variable response to therapy. A 36-year-old male presented with memory
impairment, excessive sleepiness, and slurred speech. Brain magnetic resonance imaging revealed hyperintensities
in the temporal lobes and hypothalamus, all suggestive of limbic encephalitis. He was found to have a mixed
germ cell testicular teratoma. Screening for commonly associated antibodies did not yield positive results, which
emphasizes that sero-negative PLE can be missed in patients with malignancies. In reporting this case, we urge
neurologists to consider PLE as part of the differential diagnosis in similar ambiguous clinical scenarios.

Keywords: Paraneoplastic syndrome, limbic encephalitis, testicular mixed germ cell tumor

INTRODUCTION
Paraneoplastic limbic encephalitis (PLE) is a rare syndrome characterized by confusion of acute onset, mood
[1]
changes, hallucinations, loss of short term memory, and seizures . The pathogenesis is not fully understood
but is thought to be due to autoimmune cross reactivity.

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

www.nnjournal.net