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A 49-year-old male presented in an acutely confused state. His examination and basic blood tests were unremarkable. He was started on intravenous aciclovir and an MRI brain scan showed changes consistent with limbic encephalitis. Serum antibodies including para-neoplastic auto-antibodies and cerebrospinal fluid studies were arranged along with a full body CT scan to look for malignancy. All antibody tests returned negative and the CT scan ruled out the presence of malignancy. The patient improved following treatment with intravenous immunoglobulin and was discharged. Follow-up imaging showed significant radiological improvement. He has been able to return to work and repeat CT scans have failed to find evidence of malignancy. A rare and treatable cause for his illness was found. It is worth considering limbic encephalitis when facing a confused patient especially in the young and middle-aged population.
Limbic encephalitis is a rare condition that is associated with malignancy and an ultimately poor prognosis. It presents as an acute confusional state and so may be seen by the general physician on call. We have encountered a case with no identifiable auto-antibodies or evidence of malignancy where the patient has been treated successfully and has been able to return to work. This is a rare case of limbic encephalitis to have a good prognosis, absent antibodies and no underlying identifiable malignancy.
There are two types of limbic encephalitis, paraneoplastic and non-paraneoplastic.1 We believe that our patient has non-paraneoplastic limbic encephalitis, a condition that is documented in the literature. Non-paraneoplastic limbic encephalitis is a rare treatable cause of encephalitis. No known association between limbic encephalitis and neurofibromatosis has been reported and all documented cases were found to be associated with antibodies with or without malignancy.
The striking feature in this case is the substantial clinical and radiological improvement in this patient's condition to the point that he has been able to return to work. Generally the condition carries a poor prognosis owing to the known association with malignancy.1 3 6–8 The excellent progress of the clinical condition in our patient makes hidden underlying malignancy extremely unlikely. The memory impairment is often irreversible and both these features of the condition have a profound and distressing effect on the patient and the carer's quality of life.9
Competing interests None.
Patient consent Obtained.