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

BMJ Case Rep. 2017 May 24;2017:bcr2016218088. doi: 10.1136/bcr-2016-218088.

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.

Keywords: general surgery; medical education; resuscitation; trauma.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Autoantibodies / blood
  • Carcinoma, Small Cell / complications*
  • Carcinoma, Small Cell / diagnostic imaging
  • Carcinoma, Small Cell / pathology
  • Cognitive Dysfunction / complications
  • Cognitive Dysfunction / diagnosis*
  • Confusion / diagnosis
  • Confusion / etiology*
  • Delirium / complications*
  • ELAV Proteins / immunology
  • Fatal Outcome
  • Female
  • Humans
  • Lung Neoplasms / diagnostic imaging
  • Lung Neoplasms / pathology
  • Lymph Nodes / diagnostic imaging
  • Lymph Nodes / pathology
  • Pacemaker, Artificial / adverse effects
  • Paraneoplastic Polyneuropathy / immunology
  • Paraneoplastic Syndromes, Nervous System / complications*
  • Paraneoplastic Syndromes, Nervous System / etiology
  • Paraneoplastic Syndromes, Nervous System / immunology
  • Small Cell Lung Carcinoma / complications*
  • Small Cell Lung Carcinoma / diagnostic imaging
  • Small Cell Lung Carcinoma / pathology
  • Tomography, X-Ray Computed / methods
  • Urinary Tract Infections / complications*
  • Urinary Tract Infections / diagnosis

Substances

  • Autoantibodies
  • ELAV Proteins