A case of confusion: paraneoplastic encephalomyelitis in an elderly patient suspected of having urinary tract infection-associated delirium

Abstract

Acute confusion is a common symptom of physical illness in the older patient. In the majority, it is transient and resolves on treatment of precipitants. In a subset of patients, however, neurological decline is progressive, raising concern about a serious underlying cause. We describe the case of a 71-year-old woman who developed progressive cognitive impairment following insertion of a permanent pacemaker for sinoatrial arrests. An initial diagnosis of delirium secondary to a urinary tract infection was suspected; however, the patient became increasingly confused despite treatment. Laboratory tests revealed serum anti-Hu paraneoplastic antibodies, and CT chest identified an occult lung tumour. Cervical lymph node histopathology confirmed a diagnosis of small cell carcinoma of the lung. Although a rare cause of confusion, paraneoplastic encephalomyelitis should be recognised early to allow timely identification and treatment of the associated cancer.

Prevalence of Anti-neural Autoantibodies in a Psychiatric Patient Cohort-Paradigmatic Application of Criteria for Autoimmune-Based Psychiatric Syndromes

“…Less is known about autoimmune processes in delirium, although we know that several cytokines related to autoinflammation can be elevated such as interleukin 6, interleukin-1ß and tumor necrosis factor alpha ( 8 – 10 ). Furthermore, cell membrane-surface ( 11 – 16 ) and intracellular antibodies ( 17 , 18 ) have been reported in delirium states. Neural autoantibodies occur in cognitive impairment ( 1 , 3 – 5 ), which is known to be a risk factor for triggering delirium ( 19 ).…”