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Anti-Hu antibody encephalitis is rare but debilitating paraneoplastic disorder. The clinical presentation can be highly variable. We present two cases of anti-Hu encephalitis demonstrating diversity of clinical symptoms and difficultly with clinical management. Case one discusses a 70-year-old female who presented with recurrent falls and was found to have a mediastinal mass, possible thymoma, with anti-Hu antibody positivity. She declined biopsy or resective surgery hence was treated with high dose steroids leading to stability, but not resolution, of her neurologic symptom burden. She remains functionally well and is living independently in the community. Case 2 discusses a 56 year old female who presented with recurrent seizures and later developed ataxia. She was found to have small cell lung cancer and anti-Hu antibody positivity. She was treated initially with chemoradiotherapy leading to cancer remission but progression of her neurological symptoms. She had recurrent episodes of status epilepticus and required multiple classes of antiseizure medication, high doses of methyl prednisolone, rituximab and intravenous immunoglobin to achieve disease stability. Unfortunately due to the severity of her neurological symptom burden she has been left with significant disability, unable to mobilise with ongoing ataxia and rare seizures. These two cases highlight the variability of clinical presentation, disease trajectory and outcomes in Anti-Hu antibody encephalitis. Review of the literature reveals a lack of consistency with treatment recommendations, illustrating the need for ongoing research in this area.