J Breast Cancer.  2021 Feb;24(1):106-116. 10.4048/jbc.2021.24.e2.

Paraneoplastic Encephalitis Associated with Locally Advanced Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer

Affiliations
  • 1Division of Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora, USA
  • 2Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, USA

Abstract

Paraneoplastic neurologic diseases (PND) are rare but can occur in patients with common malignancies including breast cancer. In patients with hormone receptor (HR)-negative human epidermal growth factor receptor 2 (HER2)-positive breast cancer, PND have been reported in association with anti-Yo antibodies and with clinical presentation of paraneoplastic cerebellar degeneration. We describe the case of a woman with progressively altered mental status and seizures, ultimately requiring admission. Based on her clinical presentation, imaging findings, and evidence of neural-directed antibodies in her serum and cerebrospinal fluid, she was diagnosed with paraneoplastic limbic encephalitis (LE) due to an underlying HR-negative, HER2-positive breast cancer. She showed a transient response to immunosuppression but had more significant improvement after surgical resection and initiation of chemotherapy along with HER2-directed therapy. To the best of our knowledge, this is the first documented case of paraneoplastic LE in a patient with HR-negative, HER2-positive breast cancer likely caused by the production of an unclassified anti-neuronal antibody.

Keyword

Autoimmunity; Breast neoplasms; ERBB2 protein; human; Limbic encephalitis; Paraneoplastic syndromes; Nervous system
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