Paraneoplastic CRMP-5 basal ganglionitis and limbic encephalitis in an elderly Indian lady

摘要

Sir,Collapsin response mediator proteins (CRMP) are a group of five phosphoproteins that play a vital role in neurite outgrowth and neuronal polarity.111 Anti-CRMP-5 antibodies react with a 66 kDa protein found in the brain and the peripheral nerve.[2] Of these, paraneoplastic syndromes are well described with CRMP-5. We describe the first case of CRMP-5 associated basal ganglionitis and limbic encephalitis in an Indian lady with a primary lung tumor.A 66-year-old housewife presented with a 3 month history of abnormal behavior, logorrhea, and visual and olfactory hallucinations. She was initially evaluated by a psychiatrist for psychosis and was started on atypical neuroleptics. During our evaluation, she also complained of patchy numbness in her arms, right hip, right side of the face and tongue, and recent memory impairment. She had recently lost 12 kg of weight. On examination, she scored 19/30 on the mini mental scale examination. She had mild choreic movements involving limbs and tongue. She had impaired position and vibration sense till her ankles bilaterally with diminished reflexes in lower limb. Plantar reflexes were flexor. She also had a wide based gait, but no Rhomberg's sign or cerebellar signs. Routine blood tests, X-ray chest, and ultrasound abdomen were normal.