A RARE CASE OF CARCINOMATOUS ENCEPHALITIS AS THE PRESENTING FEATURE OF OCCULT LUNG ADENOCARCINOMA- A DIAGNOSTIC DILEMMA
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 25
Abstract
PRESENTATION OF CASE A 45-year-old female with past history of ischaemic stroke 4 months back presented with complaints of one episode of generalised tonic-clonic seizure followed by altered sensorium for the last 10 days. There was no history of fever, cough with expectoration, weight loss, anorexia, headache, visual disturbances or bowel and bladder involvement. There was no past history of pulmonary tuberculosis, epilepsy, diabetes and hypertension. There was no history of any addictions. On examination, the patient was haemodynamically stable. Patient was conscious, but not responding to verbal commands. Systemic examination showed hyperreflexia on right side with extensor plantars. Laboratory investigations showed a normal haemogram with ESR of 52 mm/hour, normal renal function test and liver function test. Chest x-ray (Figure 1) showed a homogenous opacity in the left upper lobe. An MRI Brain with gadolinium contrast (Figure 2 and 3) was done, which showed multiple tiny nodular ring enhancing lesions scattered throughout both cerebral and cerebellar hemispheres. These lesions appeared hyperintense on T2W and FLAIR. No foci of blooming were seen on GRE (T2*) images. No evidence of leptomeningeal enhancement was seen. Based on the images, differential diagnoses were tuberculosis v/s disseminated neurocysticercosis v/s malignancy considering the lesion on the lung. A CSF analysis showed normal counts, protein and normal ADA. Considering the lesion present on the chest xray CECT Thorax (Figure 4) was done, which showed multiple cavitatory nodular lesions on the left upper lobe and lower lobes which appeared to be of infective aetiology. The patient’s HIV status was negative and as there was a possibility of malignancy a CT-guided lung biopsy was done which showed a lung adenocarcinoma which was positive for PAN-CK and CK-7 on immunohistochemistry. Due to the limited resources, we had to refer the patient to a higher centre for further management
Authors and Affiliations
Sapre Chinmaye, Deshpande Shubhangi, Adalja Devina
Keywords
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- EP ID EP450664
- DOI 10.14260/jemds/2018/668
- Views 89
- Downloads 0
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