A rare case of cerebral tuberculosis and paraneoplastic encephalitis

Abstract

Voltage gated potassium channel (VGKC) antibodies are seen in many conditions including limbic encephalitis. It typically involves medial temporal lobe, and in rare instances, bilateral cerebellar lobes. Patients can present with seizures and often with alerted mental status and hallucinations. Cerebral tuberculosis (TB)tends to prefer posterior fossa and patients typically present with headache, seizures, and confusion. However, there is no particular association between VGKC encephalitis and disseminated tuberculosis. Presence of both may limit treatment options for paraneoplastic encephalitis. We present a case of a young female with disseminated TB who was also found to have atypical radiographic presentation of TB encephalitis/meningitis and VGKC antibody concerning for paraneoplastic encephalitis. The patient received treatment with steroids and immunoglobulin therapy along with treatment for disseminated tuberculosis. Overall, treatment of paraneoplastic encephalitis is limited in the presence of disseminated TB and a multidisciplinary approach should be used and clinical improvement should be monitored.