Anti-N-Methyl-D-Aspartate Receptor Encephalitis Associated With Clear Cell Renal Carcinoma: A Case Report

Abstract

Background: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a cause of autoimmune encephalitis and is characterized by epileptic seizures, psychosis, and consciousness impairments. It mostly affects young adults with ovarian cancers. We herein reported a case of anti-NMDAR encephalitis associated with clear cell renal carcinoma. Case Presentation: A 54-year-old male with headache for 1 week and mood and behavioral changes for 3 days was presented, but his clinical presentation and poor response to antiviral treatment did not support a diagnosis of viral encephalitis. Positive anti-NMDAR antibodies in serum and cerebrospinal fluid confirmed autoimmune encephalitis. A subsequent evaluation revealed a paraneoplastic etiology of a renal mass, and this was then resected and pathologically confirmed as clear cell renal carcinoma. The patient's symptoms showed improvement after resection of the mass. The patient relapsed 6 months after discharge, and the symptoms completely disappeared after treatment with corticosteroids and intravenous immunoglobulin. Conclusion: Our findings suggested that NMDAR encephalitis might be associated with clear cell renal carcinoma. When patients present with unexplained seizures, neuropsychiatric disorder, or other brain symptoms, clinicians should be careful with paraneoplastic neurological disorders. Early diagnosis and treatment of primary tumors might show improvement.

Paraneoplastic NMDA encephalitis, a case report and an extensive review of available literature

“… Clear renal cell carcinoma Yang et al. [5] M,54 Normal Yes Yes After, 17 d Methylprednisolone, IVIG Surgery Cyclophosphamide NA Almost full recovery 20 d after tumor resection. Relapse after 6 mo, treated with methylprednisolone, IVIG for 3 d, then oral prednisone for 8 mo.…”

“…Another case of a 54-year-old patient with neuropsychiatric symptoms not responding to antiviral treatment for suspected viral encephalitis who had to be sedated due to worsening of his symptoms, was found to have a clear cell renal cell carcinoma. Following tumor resection (laparoscopic partial nephrectomy) and immunotherapy, the patient improved and was later discharged [5] .…”

“…While the association between NMDAr encephalitis and renal cell carcinoma (RCC) is exceedingly rare [5] , [6] , [7] . This case report presents the clinical scenario of a 20-year-old female patient diagnosed with NMDAr encephalitis in conjunction with RCC.…”

Paraneoplastički neurološki sindrom uz karcinom bubrega

“…Most neurologic PNS present as peripheral nervous system syndromes and myopathies, as shown in Table 1. Reports on central nervous system presentation are limited to anti-NMDAR and other limbic encephalitis, thus we present the first case of PNS associated with RCC which presented as severe form of Bickerstafflike brainstem encephalitis [2,[9][10][11][12][13][14][15] . Both conditions are antibody-mediated diseases treated with pulse dose methylprednisolone and TPE, which lead to temporal clinical response, as seen in our case.…”

Anti-NMDA Receptor Encephalitis Related to Renal Cell Carcinoma: A Case Report

“…Other tumors have been reported, including lung, breast, and testicular carcinomas and rare instances of renal cell carcinoma (RCC). [3][4][5] Diagnostic criteria have been proposed and depend on clinical presentation and antibody detection in the CSF. Mainstays of therapy are immunotherapy and removal of immunological trigger when identified.…”