A rare neurological puzzle: Anti-Ma2 encephalitis linked to lung adenocarcinoma

Abstract

Anti-Ma2 encephalitis is a rare paraneoplastic syndrome, mainly associated with germ cell tumors of the testis. This case report represents an atypical presentation of anti-Ma2 encephalitis in a 65-year- old female with lung adenocarcinoma. The patient presented with neuropsychiatric symptoms such as hallucinations and loss of recent memories and systemic symptoms of weight loss and night sweats. Evaluation showed bilateral hippocampal T2 hyperintensities on MRI and positivity for anti-Ma2 antibodies in serum. Initial treatment with corticosteroids resulted in partial symptomatic improvement; however, further relapses forced us to consider other immunotherapies such as rituximab and azathioprine. In spite of persistent memory deficits, the patient regained much of her general well-being. This case report points out early recognition and multidisciplinary management in this rare syndrome, especially in atypical oncological contexts. Careful malignancy workup and early institution of immunosuppressive therapy are important steps in improving patients’ outcomes in paraneoplastic encephalitis.