LIMBIC ENCEPHALITIS ASSOCIATED WITH ANTIBODIES TO THE NMDA RECEPTOR IN HODGKIN LYMPHOMA

Abstract

Convulsions, fever, and memory loss after chemotherapy are usually due to opportunistic infection, and often attributed to infection even if CSF viral PCR examination is negative. We describe a case of limbic encephalitis in a patient with relapsed Hodgkin lymphoma, in whom antibodies to the NMDA receptor were identified in serum and CSF, and whose anterograde memory improved with aggressive immunotherapy. Paraneoplastic limbic encephalitis in Hodgkin lymphoma has been reported before,1,2 but no target antigen identified. The case adds to the clinical associations of NMDA receptor antibodies. ### Case report. A 49-year-old man developed an amnesic syndrome temporally related to a second relapse of nodular sclerosing Hodgkin lymphoma. Eight years previously he had developed a large cervical lymph node and was successfully treated with mantle radiotherapy. He received chemotherapy to treat an abdominal relapse 2 years later, and maintained remission for 5 years. Last year he relapsed with a large abdominal para-aortic mass, and 3 weeks after his first cycle of treatment, with gemcitabine and cisplatin, he developed confusion and disorientation over 2 days, culminating in a generalized seizure while driving. Initial confusion and memory loss was assumed to be postictal, but his anterograde memory deficit persisted and worsened: at worst he could encode 4 of 7 parts of an address but could not recall or recognize any components at 5 minutes. He had no evidence of a movement disorder. There was no neutropenia. Erythrocyte …